Provider Demographics
NPI:1972064475
Name:WEST PALM BEAC MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:WEST PALM BEAC MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-826-8955
Mailing Address - Street 1:902 CLINT MOORE ROAD
Mailing Address - Street 2:STE 144
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-826-8955
Mailing Address - Fax:
Practice Address - Street 1:902 CLINT MOORE ROAD
Practice Address - Street 2:STE 144
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:561-826-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies