Provider Demographics
NPI:1194830364
Name:LAURA MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:LAURA MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-822-4040
Mailing Address - Street 1:5979 NW 151ST ST
Mailing Address - Street 2:SUITE 233
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2400
Mailing Address - Country:US
Mailing Address - Phone:305-822-4040
Mailing Address - Fax:305-822-4006
Practice Address - Street 1:5979 NW 151ST ST
Practice Address - Street 2:SUITE 233
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2400
Practice Address - Country:US
Practice Address - Phone:305-822-4040
Practice Address - Fax:305-822-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313090332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23-8013467388-1OtherSALES AND USE TAX
FL32 : 04699OtherOXYGEN LICENSE
FL1313090OtherHME LICENSE
FL32 : 04699OtherOXYGEN LICENSE