MEDICARE: ELK MEDICAL SUPPLIES CORP

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	PENDING #	FL

General Provider Information

NPI Number	:	1992836480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK MEDICAL SUPPLIES CORP

Provider Business Mailing Address
First Line	:	1570 W 38TH PL
Second Line	:	SUITE 11
City	:	HIALEAH
State	:	FL
Zip	:	33012-7012
Country	:	US
Telephone Number	:	305-362-6506
Fax Number	:	305-362-6635

Provider Business Practice Location Address
First Line	:	1570 W 38TH PL
Second Line	:	SUITE 11
City	:	HIALEAH
State	:	FL
Zip	:	33012-7012
Country	:	US
Telephone Number	:	305-362-6506
Fax Number	:	305-362-6635

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA CARIDAD RODRIGUEZ
Credential	:
Telephone Number	:	305-362-6506

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/19/2007

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