Provider Demographics
NPI:1891731352
Name:SUPPORT PLUS MEDICAL, INC
Entity Type:Organization
Organization Name:SUPPORT PLUS MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1866-901-4506
Mailing Address - Street 1:904 SE PRIMA VISTA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2306
Mailing Address - Country:US
Mailing Address - Phone:772-408-5840
Mailing Address - Fax:888-262-0475
Practice Address - Street 1:8241 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7950
Practice Address - Country:US
Practice Address - Phone:772-873-0081
Practice Address - Fax:888-262-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4576790001Medicare NSC