Provider Demographics
NPI:1679563001
Name:FAMILY MEDICAL SUPPLY, CORP
Entity Type:Organization
Organization Name:FAMILY MEDICAL SUPPLY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-267-0648
Mailing Address - Street 1:PO BOX 5004
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-5004
Mailing Address - Country:US
Mailing Address - Phone:787-267-0648
Mailing Address - Fax:787-267-0648
Practice Address - Street 1:2 CALLE DR GATELL
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3645
Practice Address - Country:US
Practice Address - Phone:787-267-0648
Practice Address - Fax:787-267-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR994400OtherMMM HEALTCARE
PR55295FAOtherTRIPLE S
PR994400OtherMMM HEALTCARE