Provider Demographics
NPI:1831479237
Name:AMPLE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:AMPLE MEDICAL SUPPLIES, LLC
Other - Org Name:AMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:979-216-6132
Mailing Address - Street 1:630 S SAPODILLA AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-4178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 S SAPODILLA AVENUE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4178
Practice Address - Country:US
Practice Address - Phone:979-216-6132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60-8015702601-8332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies