Provider Demographics
NPI:1033690094
Name:SUPREME MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:SUPREME MEDICAL SUPPLY LLC
Other - Org Name:SUPREME MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-378-8525
Mailing Address - Street 1:4613 N UNIVERSITY DR # 443
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4602
Mailing Address - Country:US
Mailing Address - Phone:954-803-1294
Mailing Address - Fax:954-271-4464
Practice Address - Street 1:1761 W HILLSBORO BLVD STE 325
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1562
Practice Address - Country:US
Practice Address - Phone:954-378-8525
Practice Address - Fax:954-271-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies