=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467047233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW WAY MED SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2021
-----------------------------------------------------
Last Update Date | 03/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8358 W OAKLAND PARK BLVD STE 203B
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-368-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8358 W OAKLAND PARK BLVD STE 203B
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-368-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | CALEB ESPINOZA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 195-470-9795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------