Healthcare Provider Details

I. General information

NPI: 1972274207
Provider Name (Legal Business Name): ONE HEART MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SW 81ST TER
NORTH LAUDERDALE FL
33068-1017
US

IV. Provider business mailing address

380 SW 81ST TER
NORTH LAUDERDALE FL
33068-1017
US

V. Phone/Fax

Practice location:
  • Phone: 954-709-6104
  • Fax:
Mailing address:
  • Phone: 954-709-6104
  • Fax:

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: MADELINE LAWSON
Title or Position: CEO/OWNER
Credential:
Phone: 954-709-6104