Provider Demographics
NPI:1598993941
Name:FLORENCE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:FLORENCE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-455-1341
Mailing Address - Street 1:1216 W FLORENCE AVE
Mailing Address - Street 2:1/2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2510
Mailing Address - Country:US
Mailing Address - Phone:323-455-1341
Mailing Address - Fax:323-455-1341
Practice Address - Street 1:1216 W FLORENCE AVE
Practice Address - Street 2:1/2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2510
Practice Address - Country:US
Practice Address - Phone:323-455-1341
Practice Address - Fax:323-455-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6562880001Medicare NSC