Healthcare Provider Details

I. General information

NPI: 1629537139
Provider Name (Legal Business Name): INTERNATIONAL MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 NW 138TH ST UNIT 2
HIALEAH GARDENS FL
33018-1107
US

IV. Provider business mailing address

10810 NW 138TH ST UNIT 2
HIALEAH GARDENS FL
33018-1107
US

V. Phone/Fax

Practice location:
  • Phone: 954-760-9255
  • Fax: 954-760-4741
Mailing address:
  • Phone: 954-760-9255
  • Fax: 954-760-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. YUDIT YCASA
Title or Position: MANAGER
Credential:
Phone: 954-760-9255