MEDICARE: SUPPORT SUPPLY CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	3202292	FL
2	332B00000X	Durable Medical Equipment & Medical Supplies	70	FL

General Provider Information

NPI Number	:	1063406791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SUPPLY CO

Provider Business Mailing Address
First Line	:	2115 W 60TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2616
Country	:	US
Telephone Number	:	305-827-2322
Fax Number	:	305-827-0081

Provider Business Practice Location Address
First Line	:	2115 W 60TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2616
Country	:	US
Telephone Number	:	305-827-2322
Fax Number	:	305-827-0081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ODALYS A PARDO
Credential	:
Telephone Number	:	305-827-2322

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	12/05/2007

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Directions to “SUPPORT SUPPLY CO ” Practice Location

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