Provider Demographics
NPI:1073013140
Name:CLAYTON SUPPLY RESOURCES LLC
Entity Type:Organization
Organization Name:CLAYTON SUPPLY RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VESPUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-215-3254
Mailing Address - Street 1:2755 S FEDERAL HWY STE 17
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7743
Mailing Address - Country:US
Mailing Address - Phone:561-509-0334
Mailing Address - Fax:
Practice Address - Street 1:2755 S FEDERAL HWY STE 17
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7743
Practice Address - Country:US
Practice Address - Phone:561-509-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies