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General NPI Number Information
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NPI Number | 1639116866
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Entity Type | Organization
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Legal Business Name | KINGS GRANT MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13605 SW 149TH AVE SUITE # 9
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City | MIAMI
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State | FL
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Zip | 33196-5057
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Country | US
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Telephone | 786-573-4200
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Fax | 305-278-9046
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Provider Business Mailing Address
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Address Line | 14861 SW 160TH ST
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City | MIAMI
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State | FL
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Zip | 33187-0800
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Country | US
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Telephone | 305-233-1209
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Fax | 305-278-9046
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MIRTA MORALES
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Credential |
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Telephone | 786-573-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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