Provider Demographics
NPI:1417991233
Name:MS SUPPLY & HOME HEALTH CO.
Entity Type:Organization
Organization Name:MS SUPPLY & HOME HEALTH CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-621-2001
Mailing Address - Street 1:PO BOX 2642
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-2642
Mailing Address - Country:US
Mailing Address - Phone:813-621-2001
Mailing Address - Fax:813-621-2480
Practice Address - Street 1:500 E KENNEDY BLVD STE 411
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4934
Practice Address - Country:US
Practice Address - Phone:813-787-8375
Practice Address - Fax:813-701-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FLP02000003509332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032330600Medicaid
FL109683Medicare Oscar/Certification
FL4393060001Medicare NSC