MEDICARE: ENCORE MEDICAL SUPPLY, 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	:	1427706308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	1515 N UNIVERSITY DR STE 115
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6084
Country	:	US
Telephone Number	:	954-281-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N UNIVERSITY DR STE 115
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6084
Country	:	US
Telephone Number	:	954-281-8222
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CLINT PASALODOS
Credential	:
Telephone Number	:	954-281-8222

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/23/2022

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