Healthcare Provider Details

I. General information

NPI: 1891731352
Provider Name (Legal Business Name): SUPPORT PLUS MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8241 BUSINESS PARK DR
PORT SAINT LUCIE FL
34952-7950
US

IV. Provider business mailing address

904 SE PRIMA VISTA BLVD SUITE 200
PORT SAINT LUCIE FL
34952-2306
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-0081
  • Fax: 888-262-0475
Mailing address:
  • Phone: 772-408-5840
  • Fax: 888-262-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH TROWBRIDGE
Title or Position: PRESIDENT/BOARD CHAIR
Credential:
Phone: 18669014506