=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811502800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED SUPPLIES RUS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2020
-----------------------------------------------------
Last Update Date | 09/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MED SUPPLIES R US, LLC, 1489 PAL METTO PARK RD. SUITE 509 E
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-2896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 611266
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-2896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/ MEMBER
-----------------------------------------------------
Name | MR. DAVID MICHAEL GOLDSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-799-2896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------