Provider Demographics
NPI:1104046218
Name:MEDIC SURGICAL SUPPLY
Entity Type:Organization
Organization Name:MEDIC SURGICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLAMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-1315
Mailing Address - Street 1:1401 W FLAGLER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2254
Mailing Address - Country:US
Mailing Address - Phone:305-642-1315
Mailing Address - Fax:305-642-0012
Practice Address - Street 1:1401 W FLAGLER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2254
Practice Address - Country:US
Practice Address - Phone:305-642-1315
Practice Address - Fax:305-642-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312614332B00000X
FL324241332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0321910001Medicare ID - Type Unspecified