Provider Demographics
NPI:1700409489
Name:MISTY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MISTY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RACIEL
Authorized Official - Middle Name:SERRA
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-490-8920
Mailing Address - Street 1:649 US HIGHWAY 1 STE 8
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4616
Mailing Address - Country:US
Mailing Address - Phone:561-678-2065
Mailing Address - Fax:
Practice Address - Street 1:649 US HIGHWAY 1 STE 8
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4616
Practice Address - Country:US
Practice Address - Phone:561-678-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies