Healthcare Provider Details

I. General information

NPI: 1063511129
Provider Name (Legal Business Name): BOCA MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GLADES RD
BOCA RATON FL
33431-6414
US

IV. Provider business mailing address

620 GLADES RD
BOCA RATON FL
33431-6414
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-7430
  • Fax: 561-368-7401
Mailing address:
  • Phone: 561-368-7430
  • Fax: 561-368-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2140
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 4369
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORF113
License Number StateFL

VIII. Authorized Official

Name: MR. CARL L ENGLISH
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-368-7430