MEDICARE: CITY 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

General Provider Information

NPI Number	:	1538105085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1901 NW 7TH ST
Second Line	:	SUITE 107
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-260-9177
Fax Number	:	305-260-9872

Provider Business Practice Location Address
First Line	:	1901 NW 7TH ST
Second Line	:	SUITE 107
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-260-9177
Fax Number	:	305-260-9872

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ALFREDO VILLAVERDE ZAYAS
Credential	:
Telephone Number	:	305-260-9177

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

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