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NPI Code Detail

MEDICARE: BASE MEDICAL SUPPLY INC.

MEDICARE: BASE 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1275042483
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASE MEDICAL SUPPLY INC.
Provider Business Mailing Address
First Line : 130 S INDIAN RIVER DR STE 202
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4353
Country : US
Telephone Number : 772-618-1183
Fax Number : 772-672-3014
Provider Business Practice Location Address
First Line : 130 S INDIAN RIVER DR STE 202
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4353
Country : US
Telephone Number : 772-618-1183
Fax Number : 772-672-3014
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. CLIFFORD TODD MONAGHAN
Credential :
Telephone Number : 772-618-1183
Provider Enumeration Date : 09/20/2017
Last Update Date : 07/21/2022

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Directions to “BASE MEDICAL SUPPLY INC. ” Practice Location

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