Provider Demographics
NPI:1760403851
Name:ONE STOP MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:ONE STOP MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRUZHININ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-947-8960
Mailing Address - Street 1:3773 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4104
Mailing Address - Country:US
Mailing Address - Phone:305-947-8960
Mailing Address - Fax:305-947-8322
Practice Address - Street 1:3773 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4104
Practice Address - Country:US
Practice Address - Phone:305-947-8960
Practice Address - Fax:305-947-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32:02499332BX2000X
FL1071332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022366200Medicaid
FL3930480001Medicare NSC