Provider Demographics
NPI:1518674142
Name:FITZSIMMONS SURGICAL SUPPLY INC
Entity Type:Organization
Organization Name:FITZSIMMONS SURGICAL SUPPLY INC
Other - Org Name:FITZSIMMONS HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-532-1199
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7927
Mailing Address - Country:US
Mailing Address - Phone:708-532-1199
Mailing Address - Fax:708-532-4499
Practice Address - Street 1:1450 SW 3RD ST STE A-10
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3215
Practice Address - Country:US
Practice Address - Phone:954-363-1305
Practice Address - Fax:954-603-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118472300Medicaid