Provider Demographics
NPI:1164414959
Name:ABC MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ABC MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-4651
Mailing Address - Street 1:7821 CORAL WAY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6542
Mailing Address - Country:US
Mailing Address - Phone:305-266-4651
Mailing Address - Fax:305-262-3988
Practice Address - Street 1:7821 CORAL WAY
Practice Address - Street 2:SUITE 129
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6542
Practice Address - Country:US
Practice Address - Phone:305-266-4651
Practice Address - Fax:305-262-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9079OtherDURABLE MEDICAL EQUIPMENT
FL1288990001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT