Provider Demographics
NPI:1225063738
Name:L AND M MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:L AND M MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:JOSEFA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-681-6966
Mailing Address - Street 1:1745 W 37TH ST
Mailing Address - Street 2:UNIT 17
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4677
Mailing Address - Country:US
Mailing Address - Phone:305-681-6966
Mailing Address - Fax:305-681-6019
Practice Address - Street 1:1745 W 37TH ST
Practice Address - Street 2:UNIT 17
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4677
Practice Address - Country:US
Practice Address - Phone:305-681-6966
Practice Address - Fax:305-681-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL951351500Medicaid
FL951351500Medicaid