Healthcare Provider Details

I. General information

NPI: 1487306155
Provider Name (Legal Business Name): ELEGANCE MEDICAL SUPPLY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8358 W OAKLAND PARK BLVD STE 203D
SUNRISE FL
33351-7341
US

IV. Provider business mailing address

8358 W OAKLAND PARK BLVD STE 203D
SUNRISE FL
33351-7341
US

V. Phone/Fax

Practice location:
  • Phone: 754-336-1232
  • Fax:
Mailing address:
  • Phone: 754-336-1232
  • Fax:

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: WALTER PRADO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 754-336-1232