Healthcare Provider Details

I. General information

NPI: 1841109279
Provider Name (Legal Business Name): SR ORTHOPEDIC SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 WASHINGTON AVE # 660
MIAMI BEACH FL
33139-6600
US

IV. Provider business mailing address

404 WASHINGTON AVE # 660
MIAMI BEACH FL
33139-6600
US

V. Phone/Fax

Practice location:
  • Phone: 305-205-0405
  • Fax:
Mailing address:
  • Phone: 305-600-1482
  • Fax:

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: RONALD W RILEY
Title or Position: MANAGING PARTNER
Credential:
Phone: 305-205-0405