Provider Demographics
NPI:1568828267
Name:EMPIRE MEDICAL EQUIPMENT AND SUPPLIES LLC
Entity Type:Organization
Organization Name:EMPIRE MEDICAL EQUIPMENT AND SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-717-1066
Mailing Address - Street 1:7900 GLADES RD STE 650
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4172
Mailing Address - Country:US
Mailing Address - Phone:561-852-7267
Mailing Address - Fax:561-483-3105
Practice Address - Street 1:7900 GLADES RD STE 650
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4172
Practice Address - Country:US
Practice Address - Phone:561-852-7267
Practice Address - Fax:561-483-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7518210001Medicare NSC