Healthcare Provider Details

I. General information

NPI: 1861484958
Provider Name (Legal Business Name): AUSTIN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5327 NW 36TH AVE
MIAMI FL
33142-3205
US

IV. Provider business mailing address

5327 NW 36TH AVE
MIAMI FL
33142-3205
US

V. Phone/Fax

Practice location:
  • Phone: 306-638-7996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number321289
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number715
License Number StateFL

VIII. Authorized Official

Name: MARTHA REYES
Title or Position: PRESIDENT
Credential:
Phone: 305-638-7996