Provider Demographics
NPI:1073613006
Name:YAMATO MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:YAMATO MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-218-8800
Mailing Address - Street 1:9101 LAKERIDGE BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2181
Mailing Address - Country:US
Mailing Address - Phone:561-613-2731
Mailing Address - Fax:561-477-8794
Practice Address - Street 1:9101 LAKERIDGE BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2181
Practice Address - Country:US
Practice Address - Phone:561-613-2731
Practice Address - Fax:561-477-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4405860001Medicare ID - Type UnspecifiedPROVIDER NUMBER