=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073532941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPREME SERVICE MEDICAL EQUIPMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7446 NW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-388-0409
-----------------------------------------------------
Fax | 786-388-0408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7446 NW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-388-0409
-----------------------------------------------------
Fax | 786-388-0408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. YURI PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-388-0409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------