Healthcare Provider Details

I. General information

NPI: 1154508695
Provider Name (Legal Business Name): BOCA MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W PALMETTO PARK RD
BOCA RATON FL
33486-3313
US

IV. Provider business mailing address

1307 W PALMETTO PARK RD
BOCA RATON FL
33486-3313
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-7430
  • Fax: 561-368-7401
Mailing address:
  • Phone: 561-368-7430
  • Fax: 561-368-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313416
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORF 113
License Number StateFL

VIII. Authorized Official

Name: CARL L ENGLISH
Title or Position: MGMR
Credential:
Phone: 561-368-7430