Provider Demographics
NPI:1366439960
Name:S.G. MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:S.G. MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-804-0268
Mailing Address - Street 1:50 AVE LIBORIO LOPEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2032
Mailing Address - Country:US
Mailing Address - Phone:787-804-0268
Mailing Address - Fax:787-804-0268
Practice Address - Street 1:50 AVE LIBORIO LOPEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2032
Practice Address - Country:US
Practice Address - Phone:787-804-0268
Practice Address - Fax:787-804-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1514C332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50378OtherPROVIDER NUMBER
PR50378OtherPROVIDER NUMBER