Provider Demographics
NPI:1851486674
Name:MEDICAL SUPPLY STORE #1
Entity Type:Organization
Organization Name:MEDICAL SUPPLY STORE #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:ZION
Authorized Official - Last Name:KUNCMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-933-9137
Mailing Address - Street 1:1831 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6001
Mailing Address - Country:US
Mailing Address - Phone:954-933-9137
Mailing Address - Fax:954-752-9447
Practice Address - Street 1:1831 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6001
Practice Address - Country:US
Practice Address - Phone:954-933-9137
Practice Address - Fax:954-752-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313370332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9710OtherBCBS
FL5328150001Medicare NSC