Healthcare Provider Details

I. General information

NPI: 1932114667
Provider Name (Legal Business Name): MEDICAL STORE OF PALM BEACH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTHPOINT PKWY SUITE 301
WEST PALM BEACH FL
33407-1979
US

IV. Provider business mailing address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-6200
  • Fax: 561-242-6240
Mailing address:
  • Phone: 561-848-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1030
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1030
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID C. FIELDING
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 561-848-5200