Provider Demographics
NPI:1417960444
Name:SARED MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SARED MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-836-2503
Mailing Address - Street 1:102 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-2007
Mailing Address - Country:US
Mailing Address - Phone:787-836-2503
Mailing Address - Fax:787-836-2503
Practice Address - Street 1:102 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-2007
Practice Address - Country:US
Practice Address - Phone:787-836-2503
Practice Address - Fax:787-836-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0891999332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1321890001Medicare NSC