Healthcare Provider Details

I. General information

NPI: 1538397880
Provider Name (Legal Business Name): INDIAN ROCKS MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GULF BLVD STE 101
INDIAN ROCKS BEACH FL
33785-2732
US

IV. Provider business mailing address

1201 GULF BLVD STE 101
INDIAN ROCKS BEACH FL
33785-2732
US

V. Phone/Fax

Practice location:
  • Phone: 727-595-1300
  • Fax: 727-595-1300
Mailing address:
  • Phone: 727-595-1300
  • Fax: 727-595-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM C KOENIG
Title or Position: OWNER
Credential:
Phone: 727-595-1300