=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811930167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASTER MEDICAL SUPPLIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD STE 2K-5
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9164
-----------------------------------------------------
Fax | 305-229-0969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD STE 2K-5
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9164
-----------------------------------------------------
Fax | 305-229-0969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRTESIDENT
-----------------------------------------------------
Name | EVARISTA SENTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-229-9164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------