MEDICARE: PREFERED MEDICAL EQUIPMENT SUPPLY

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	AHCA HME LIC #316	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M2573	OTHER		BCBS OUT OF NETWORK

General Provider Information

NPI Number	:	1881686830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERED MEDICAL EQUIPMENT SUPPLY

Provider Business Mailing Address
First Line	:	3675 DAVIE BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-3439
Country	:	US
Telephone Number	:	954-321-3555
Fax Number	:	954-321-5477

Provider Business Practice Location Address
First Line	:	3675 DAVIE BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-3439
Country	:	US
Telephone Number	:	954-321-3555
Fax Number	:	954-321-5477

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. MERCEDES RODRIGUEZ
Credential	:
Telephone Number	:	954-321-3555

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/22/2020

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