Provider Demographics
NPI:1376013482
Name:VIOLET MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:VIOLET MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KABOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-935-6350
Mailing Address - Street 1:2435 US HIGHWAY 19 STE 580
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3905
Mailing Address - Country:US
Mailing Address - Phone:727-935-6350
Mailing Address - Fax:
Practice Address - Street 1:2435 US HIGHWAY 19 STE 580
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3905
Practice Address - Country:US
Practice Address - Phone:727-935-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies