Provider Demographics
NPI:1386649127
Name:MASTERCARE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:MASTERCARE MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-229-1770
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD
Mailing Address - Street 2:STE 1N5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4511
Mailing Address - Country:US
Mailing Address - Phone:305-229-1770
Mailing Address - Fax:305-229-2857
Practice Address - Street 1:175 FONTAINEBLEAU BLVD
Practice Address - Street 2:STE 1N5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4511
Practice Address - Country:US
Practice Address - Phone:305-229-1770
Practice Address - Fax:305-229-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL149332B00000X
FL32:00287332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212216OtherHME FOR AMERIGROUP HMO
FL0561620001Medicare ID - Type UnspecifiedHME