Provider Demographics
NPI:1710973706
Name:SPIRAL TECH MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SPIRAL TECH MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-821-1440
Mailing Address - Street 1:15321 NW 60TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2484
Mailing Address - Country:US
Mailing Address - Phone:305-821-1440
Mailing Address - Fax:305-821-4361
Practice Address - Street 1:15321 NW 60TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2484
Practice Address - Country:US
Practice Address - Phone:305-821-1440
Practice Address - Fax:305-821-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2328332BX2000X
FL32:03270332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4635660001Medicare ID - Type UnspecifiedFLORIDA MEDICARE