MEDICARE: TITAN MEDICAL 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	:	1760949291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TITAN MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	3900 WOODLAKE BLVD STE 207C
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3010
Country	:	US
Telephone Number	:	561-370-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 WOODLAKE BLVD STE 207C
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3010
Country	:	US
Telephone Number	:	561-370-3364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMMANUEL PEREZ
Credential	:
Telephone Number	:	561-370-3364

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	08/27/2019

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