Provider Demographics
NPI:1154643195
Name:ROYAL PALM MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ROYAL PALM MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-306-1536
Mailing Address - Street 1:941 S MILITARY TRL # F9
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3980
Mailing Address - Country:US
Mailing Address - Phone:561-253-0453
Mailing Address - Fax:954-541-8525
Practice Address - Street 1:941 S MILITARY TRL STE F9
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3980
Practice Address - Country:US
Practice Address - Phone:561-253-0453
Practice Address - Fax:877-849-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF153332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1313676OtherACHA
FL1313676OtherACHA