MEDICARE: MY TOWN MEDICAL SUPPLIES LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1033672399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY TOWN MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	10 S NEW RIVER DR E STE 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2810
Country	:	US
Telephone Number	:	954-765-6856
Fax Number	:	954-208-9037

Provider Business Practice Location Address
First Line	:	10 S NEW RIVER DR E STE 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2810
Country	:	US
Telephone Number	:	954-765-6856
Fax Number	:	954-208-9037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDROS RODRIGUEZ CAPOTE
Credential	:
Telephone Number	:	549-765-6856

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	04/12/2019

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