MEDICARE: MY MEDICAL SUPPLIES, 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	:	1710324447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	1421 E BROAD STREET
Second Line	:	SUITE 241
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	919-762-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 E BROAD STREET
Second Line	:	SUITE 241
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	919-762-5088
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMON FURELOS
Credential	:
Telephone Number	:	919-762-5088

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	10/17/2014

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