MEDICARE: MA MEDICAL SUPPLY 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	2324	FL

General Provider Information

NPI Number	:	1942382296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	5850 SW 8TH ST
Second Line	:	STE 2
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5036
Country	:	US
Telephone Number	:	305-265-8683
Fax Number	:	305-265-8966

Provider Business Practice Location Address
First Line	:	5850 SW 8TH ST
Second Line	:	STE 2
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5036
Country	:	US
Telephone Number	:	305-265-8683
Fax Number	:	305-265-8966

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELITAM LLANES
Credential	:
Telephone Number	:	305-265-8683

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/31/2008

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