Provider Demographics
NPI:1144391830
Name:M C MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:M C MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-823-9021
Mailing Address - Street 1:900 W 49TH ST STE 550
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3442
Mailing Address - Country:US
Mailing Address - Phone:305-823-9021
Mailing Address - Fax:305-823-9022
Practice Address - Street 1:900 W 49TH ST STE 550
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3442
Practice Address - Country:US
Practice Address - Phone:305-823-9021
Practice Address - Fax:305-823-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN
FL5686480001Medicare ID - Type UnspecifiedPROVIDER