=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760403851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE STOP MEDICAL SUPPLIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 02/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3773 NE 163RD ST
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-947-8960
-----------------------------------------------------
Fax | 305-947-8322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3773 NE 163RD ST
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-947-8960
-----------------------------------------------------
Fax | 305-947-8322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALLA A PRUZHININ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-947-8960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 32:02499
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 1071
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------