MEDICARE: M.B.M 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	332B00000X	Durable Medical Equipment & Medical Supplies	1312387	FL

General Provider Information

NPI Number	:	1386671360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.B.M MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	6363 TALFT STREET
Second Line	:	SUITE 311
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024
Country	:	US
Telephone Number	:	954-965-9173
Fax Number	:	954-965-9174

Provider Business Practice Location Address
First Line	:	6363 TAFT ST
Second Line	:	SUITE 311
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5962
Country	:	US
Telephone Number	:	954-965-9173
Fax Number	:	954-965-9174

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	MRS. BERTA MEJIAS
Credential	:
Telephone Number	:	954-965-9173

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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