Provider Demographics
NPI:1710120464
Name:MTR MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:MTR MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-456-5600
Mailing Address - Street 1:3389 SHERIDAN ST
Mailing Address - Street 2:547
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3606
Mailing Address - Country:US
Mailing Address - Phone:954-456-5600
Mailing Address - Fax:954-894-1818
Practice Address - Street 1:3363 SHERIDAN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3664
Practice Address - Country:US
Practice Address - Phone:954-456-5600
Practice Address - Fax:954-894-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313559332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0938970001Medicare NSC