Healthcare Provider Details

I. General information

NPI: 1891179586
Provider Name (Legal Business Name): PAYLESS MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N FAYETTEVILLE ST STE J
LIBERTY NC
27298-3203
US

IV. Provider business mailing address

13910 LYNMAR BLVD
TAMPA FL
33626-3123
US

V. Phone/Fax

Practice location:
  • Phone: 866-533-0772
  • Fax: 866-629-5786
Mailing address:
  • Phone: 866-533-0772
  • Fax: 866-629-5786

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JON ROBICHAUD
Title or Position: MANAGING MEMBER
Credential:
Phone: 506-871-9455