Healthcare Provider Details

I. General information

NPI: 1497821946
Provider Name (Legal Business Name): LMC MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 PENINSULA CORPORATE CIR STE 1022
BOCA RATON FL
33487-1385
US

IV. Provider business mailing address

950 PENINSULA CORPORATE CIR STE 1022
BOCA RATON FL
33487-1385
US

V. Phone/Fax

Practice location:
  • Phone: 877-855-6655
  • Fax: 561-828-8228
Mailing address:
  • Phone: 877-855-6655
  • Fax: 561-828-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25928
License Number StateFL

VIII. Authorized Official

Name: MS. BONNIE KNICKERBOCKER
Title or Position: CEO
Credential:
Phone: 877-855-6655