Provider Demographics
NPI:1679090237
Name:SOUTH DADE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SOUTH DADE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-614-3129
Mailing Address - Street 1:8181 NW 36TH ST STE 1004
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6647
Mailing Address - Country:US
Mailing Address - Phone:786-614-3129
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST STE 1004
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6647
Practice Address - Country:US
Practice Address - Phone:786-614-3129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies