Provider Demographics
NPI:1275042483
Name:BASE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:BASE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-618-1183
Mailing Address - Street 1:130 S INDIAN RIVER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4353
Mailing Address - Country:US
Mailing Address - Phone:772-618-1183
Mailing Address - Fax:772-672-3014
Practice Address - Street 1:130 S INDIAN RIVER DR STE 202
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4353
Practice Address - Country:US
Practice Address - Phone:772-618-1183
Practice Address - Fax:772-672-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies