Provider Demographics
NPI:1639132806
Name:SL MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:SL MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERRAT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-754-8274
Mailing Address - Street 1:CALLE 45 SE REPARTO METROPOLITANO
Mailing Address - Street 2:#892
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-754-8274
Mailing Address - Fax:
Practice Address - Street 1:CALLE 45 SE REPARTO METROPOLITANO
Practice Address - Street 2:#892
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-754-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5645540001Medicare ID - Type UnspecifiedPALMETTO GBA