Healthcare Provider Details

I. General information

NPI: 1124318084
Provider Name (Legal Business Name): QUALITY MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N US HIGHWAY 1 STE 402
JUPITER FL
33477-4406
US

IV. Provider business mailing address

1001 N US HIGHWAY 1 STE 402
JUPITER FL
33477-4406
US

V. Phone/Fax

Practice location:
  • Phone: 561-746-1484
  • Fax: 561-746-7383
Mailing address:
  • Phone: 561-746-1484
  • Fax: 561-746-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. CARLOS ELISEO
Title or Position: PRESIDENT
Credential:
Phone: 561-746-1484