Provider Demographics
NPI:1326271362
Name:ADK MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ADK MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-876-5253
Mailing Address - Street 1:5203 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1407
Mailing Address - Country:US
Mailing Address - Phone:813-876-5253
Mailing Address - Fax:813-876-5289
Practice Address - Street 1:5203 N. ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2626
Practice Address - Country:US
Practice Address - Phone:813-876-5253
Practice Address - Fax:813-876-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003084900Medicaid
FL6441500001Medicare NSC