MEDICARE: AG TEAM 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	:	1700646544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG TEAM SUPPLY LLC

Provider Business Mailing Address
First Line	:	3206 FOREST HILL BLVD LOT 103
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5802
Country	:	US
Telephone Number	:	954-314-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 FOREST HILL BLVD LOT 103
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5802
Country	:	US
Telephone Number	:	954-314-7644
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ANDRES GONZALEZ
Credential	:
Telephone Number	:	954-314-7644

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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