MEDICARE: MEGA MEDICAL SUPPLY, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447637160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGA MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	4910 DYER BLVD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 DYER BLVD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1009
Country	:	US
Telephone Number	:	561-840-6566
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN LYCAN
Credential	:
Telephone Number	:	561-840-6566

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	11/16/2022

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Directions to “MEGA MEDICAL SUPPLY, LLC ” Practice Location

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