Healthcare Provider Details

I. General information

NPI: 1184552515
Provider Name (Legal Business Name): CQC MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 3RD CT STE 15
PLANTATION FL
33317-2830
US

IV. Provider business mailing address

PO BOX 91
HALLANDALE BEACH FL
33008-0091
US

V. Phone/Fax

Practice location:
  • Phone: 786-207-4788
  • Fax: 954-568-8630
Mailing address:
  • Phone: 814-449-3605
  • Fax: 954-568-8630

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: SIDNEY COUPET
Title or Position: OWNER/CEO
Credential: DO
Phone: 814-449-3605