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General NPI Number Information
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NPI Number | 1831479237
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Entity Type | Organization
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Legal Business Name | AMPLE MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 630 S SAPODILLA AVENUE SUITE 318
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-4178
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Country | US
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Telephone | 979-216-6132
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S SAPODILLA AVE SUITE 318
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-4178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GILLIAM ELLIOTT JR.
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Credential |
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Telephone | 979-216-6132
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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 | 60-8015702601-8
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License Number State | FL
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