Healthcare Provider Details

I. General information

NPI: 1336089457
Provider Name (Legal Business Name): MODERN MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST STE 835
WOONSOCKET RI
02895-3240
US

IV. Provider business mailing address

191 SOCIAL ST STE 835
WOONSOCKET RI
02895-3240
US

V. Phone/Fax

Practice location:
  • Phone: 781-458-9049
  • Fax:
Mailing address:
  • Phone: 781-458-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DANA ZIDES
Title or Position: OWNER
Credential: ZIDES
Phone: 781-458-9049