Healthcare Provider Details

I. General information

NPI: 1164481586
Provider Name (Legal Business Name): OPIS MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR SUITE 300
TAMPA FL
33610-9713
US

IV. Provider business mailing address

10150 HIGHLAND MANOR DR SUITE 300
TAMPA FL
33610-9713
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-6620
  • Fax:
Mailing address:
  • Phone: 813-558-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN G WOOD
Title or Position: PRESIDENT
Credential:
Phone: 813-558-6561