Provider Demographics
NPI:1851606974
Name:SUPPLIES UNLIMITED CORP
Entity Type:Organization
Organization Name:SUPPLIES UNLIMITED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-269-7937
Mailing Address - Street 1:2221 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-269-7937
Mailing Address - Fax:866-760-8483
Practice Address - Street 1:2221 E BROADWAY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-269-7937
Practice Address - Fax:866-760-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty