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NPI Code Detail

MEDICARE: SUPPORT PLUS MEDICAL, INC

MEDICARE: SUPPORT PLUS MEDICAL, 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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1891731352
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORT PLUS MEDICAL, INC
Provider Business Mailing Address
First Line : 904 SE PRIMA VISTA BLVD
Second Line : SUITE 200
City : PORT SAINT LUCIE
State : FL
Zip : 34952-2306
Country : US
Telephone Number : 772-408-5840
Fax Number : 888-262-0475
Provider Business Practice Location Address
First Line : 8241 BUSINESS PARK DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-7950
Country : US
Telephone Number : 772-873-0081
Fax Number : 888-262-0475
Authorized Official
Title or Position : PRESIDENT/BOARD CHAIR
Name : MR. KEITH TROWBRIDGE
Credential :
Telephone Number : 18669014506
Provider Enumeration Date : 06/22/2006
Last Update Date : 11/17/2008

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