MEDICARE: FLORIDIAN MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	32:03457	FL

General Provider Information

NPI Number	:	1023127115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDIAN MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1140 NE 163RD ST
Second Line	:	23
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4517
Country	:	US
Telephone Number	:	305-944-1223
Fax Number	:	305-944-1223

Provider Business Practice Location Address
First Line	:	1140 NE 163RD ST
Second Line	:	23
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4517
Country	:	US
Telephone Number	:	305-944-1223
Fax Number	:	305-944-1223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN PABLO DIMMER
Credential	:
Telephone Number	:	305-944-1223

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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