MEDICARE: WEST PALM BEAC MEDICAL SUPPLIES 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	:	1972064475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PALM BEAC MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	902 CLINT MOORE ROAD
Second Line	:	STE 144
City	:	BOCA RATON
State	:	FL
Zip	:	33487
Country	:	US
Telephone Number	:	561-826-8955
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 CLINT MOORE ROAD
Second Line	:	STE 144
City	:	BOCA RATON
State	:	FL
Zip	:	33487
Country	:	US
Telephone Number	:	561-826-8955
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	BENNETT AUGUSTINO
Credential	:
Telephone Number	:	561-826-8955

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	04/08/2020

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