MEDICARE: NATIONALITY MEDICAL DISTRIBUTORS, 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	:	1063718591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONALITY MEDICAL DISTRIBUTORS, LLC

Provider Business Mailing Address
First Line	:	2545 W 80TH ST
Second Line	:	13
City	:	HIALEAH
State	:	FL
Zip	:	33016-2740
Country	:	US
Telephone Number	:	786-360-4357
Fax Number	:	786-360-4429

Provider Business Practice Location Address
First Line	:	2545 W 80TH ST
Second Line	:	13
City	:	HIALEAH
State	:	FL
Zip	:	33016-2740
Country	:	US
Telephone Number	:	786-360-4357
Fax Number	:	786-360-4429

Authorized Official
Title or Position	:	MANAGER
Name	:	REYMOND RUIZ
Credential	:
Telephone Number	:	786-360-4357

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	08/05/2011

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