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General NPI Number Information
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NPI Number | 1710120464
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Entity Type | Organization
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Legal Business Name | MTR MEDICAL SUPPLY INC.
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 3363 SHERIDAN ST SUITE 212
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3664
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Country | US
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Telephone | 954-456-5600
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Fax | 954-894-1818
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Provider Business Mailing Address
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Address Line | 3389 SHERIDAN ST 547
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3606
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Country | US
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Telephone | 954-456-5600
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Fax | 954-894-1818
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Authorized Official
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Title or Position | OWNER/ GENERAL MANAGER
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Name | MR. TODD ROSENTHAL
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Credential |
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Telephone | 954-456-5600
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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 | 1313559
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License Number State | FL
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