MEDICARE: BEACH MEDICAL SUPPLIERS 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	:	1437652823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH MEDICAL SUPPLIERS LLC

Provider Business Mailing Address
First Line	:	2256 WEST GREAT NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2256 W. GREAT NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:	757-500-4476
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JORDAN BROOME
Credential	:
Telephone Number	:	757-500-4476

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	03/13/2018

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