=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588558142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE PB MEDICAL SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 VISTA PARK WAY STE 230
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-910-0529
-----------------------------------------------------
Fax | 561-910-0529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 VISTA PARK WAY STE 230
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-910-0529
-----------------------------------------------------
Fax | 561-910-0529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. PATRICIA BEAUVAIS
-----------------------------------------------------
Credential | N/A
-----------------------------------------------------
Telephone | 561-215-6551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------