Provider Demographics
NPI:1245225374
Name:ABC MEDICAL & SURGICAL SALES
Entity Type:Organization
Organization Name:ABC MEDICAL & SURGICAL SALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-846-8089
Mailing Address - Street 1:2100 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2927
Mailing Address - Country:US
Mailing Address - Phone:407-846-8089
Mailing Address - Fax:407-846-6543
Practice Address - Street 1:2100 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2927
Practice Address - Country:US
Practice Address - Phone:407-846-8089
Practice Address - Fax:407-846-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312092332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTRICARE PROVIDER NUMBER
FL=========OtherTRICARE PROVIDER NUMBER