MEDICARE: INTERNATIONAL 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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1629537139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	10810 NW 138TH ST UNIT 2
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-1107
Country	:	US
Telephone Number	:	954-760-9255
Fax Number	:	954-760-4741

Provider Business Practice Location Address
First Line	:	10810 NW 138TH ST UNIT 2
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-1107
Country	:	US
Telephone Number	:	954-760-9255
Fax Number	:	954-760-4741

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. YUDIT YCASA
Credential	:
Telephone Number	:	954-760-9255

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	04/08/2026

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