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General NPI Number Information
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NPI Number | 1780171322
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Entity Type | Organization
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Legal Business Name | CLAYTON SUPPLY RESOURCES LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 8401 LAKE WORTH RD STE 232
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City | LAKE WORTH
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State | FL
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Zip | 33467-2400
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Country | US
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Telephone | 888-698-5567
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 LAKE WORTH RD STE 232
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City | LAKE WORTH
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State | FL
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Zip | 33467-2400
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Country | US
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Telephone | 888-698-5567
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | ANTHONY A VESPUCCI
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Credential |
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Telephone | 888-698-5567
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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 | FL
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