Provider Demographics
NPI:1679658454
Name:UNIVERSITY MEDICAL SUPPLY. INC
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL SUPPLY. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-436-9541
Mailing Address - Street 1:5078 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5550
Mailing Address - Country:US
Mailing Address - Phone:305-436-9541
Mailing Address - Fax:305-436-9542
Practice Address - Street 1:5078 NW 74TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5550
Practice Address - Country:US
Practice Address - Phone:305-436-9541
Practice Address - Fax:305-436-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies