Provider Demographics
NPI:1639292386
Name:SUN MED SUPPLIES, CORP.
Entity Type:Organization
Organization Name:SUN MED SUPPLIES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAXI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-815-0060
Mailing Address - Street 1:6555 NW 36TH ST
Mailing Address - Street 2:UNIT. 321
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6978
Mailing Address - Country:US
Mailing Address - Phone:305-815-0060
Mailing Address - Fax:
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:UNIT. 321
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:305-815-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTBA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTBAMedicare UPIN