MEDICARE: PURE ARROGANCY PROSTHESIS SUPPLIES

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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L18000122273	OTHER		LLC

General Provider Information

NPI Number	:	1609401074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE ARROGANCY PROSTHESIS SUPPLIES

Provider Business Mailing Address
First Line	:	7750 OKEECHOBEE BLVD STE 4425
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2104
Country	:	US
Telephone Number	:	561-291-9882
Fax Number	:	561-516-7384

Provider Business Practice Location Address
First Line	:	7750 OKEECHOBEE BLVD STE 4425
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2104
Country	:	US
Telephone Number	:	561-291-9882
Fax Number	:	561-516-7384

Authorized Official
Title or Position	:	OWNER
Name	:	BREANNA COATS
Credential	:
Telephone Number	:	772-214-8770

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	03/06/2020

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