Provider Demographics
NPI:1023041803
Name:BI COUNTY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:BI COUNTY MEDICAL SUPPLY INC
Other - Org Name:BI COUNTY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-BATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-637-0666
Mailing Address - Street 1:1662 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5572
Mailing Address - Country:US
Mailing Address - Phone:305-637-0666
Mailing Address - Fax:305-637-0740
Practice Address - Street 1:1662 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5572
Practice Address - Country:US
Practice Address - Phone:305-637-0666
Practice Address - Fax:305-637-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21453332B00000X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031905801Medicaid
FL031905800Medicaid
1015519OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1015519OtherNCPDP PROVIDER IDENTIFICATION NUMBER