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General NPI Number Information
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NPI Number | 1871901322
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Entity Type | Organization
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Legal Business Name | SUPREME HEALTHCARE SUPPLY LLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 1035 NE 125TH ST 301
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5820
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Country | US
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Telephone | 305-859-3350
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Fax | 305-928-2535
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Provider Business Mailing Address
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Address Line | 1035 NE 125TH ST 301
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5820
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Country | US
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Telephone | 305-859-3350
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Fax | 305-928-2535
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Authorized Official
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Title or Position | OWNER
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Name | MR. IVAN E RUIZ-OTERO
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Credential |
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Telephone | 305-859-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | PED218
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License Number State | FL
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