MEDICARE: ALL STAR MEDICAL SUPPLY INC.

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

General Provider Information

NPI Number	:	1770541351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL STAR MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	200 SW 27TH AVE
Second Line	:	SUITE 208
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1255
Country	:	US
Telephone Number	:	954-585-8035
Fax Number	:	954-585-8517

Provider Business Practice Location Address
First Line	:	200 SW 27TH AVE
Second Line	:	SUITE 208
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1255
Country	:	US
Telephone Number	:	954-585-8035
Fax Number	:	954-585-8517

Authorized Official
Title or Position	:	P
Name	:	SERPOUHY DAVTIAN
Credential	:
Telephone Number	:	305-466-3899

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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