MEDICARE: MED SONIC 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	:	1760836530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED SONIC LLC

Provider Business Mailing Address
First Line	:	1001 W CYPRESS CREEK RD STE 111
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1947
Country	:	US
Telephone Number	:	954-491-8601
Fax Number	:	954-734-7302

Provider Business Practice Location Address
First Line	:	1001 W CYPRESS CREEK RD STE 111
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1947
Country	:	US
Telephone Number	:	954-491-8601
Fax Number	:	954-734-7302

Authorized Official
Title or Position	:	OWNER
Name	:	KEN PITTER
Credential	:
Telephone Number	:	954-491-8601

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/13/2017

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