Provider Demographics
NPI:1013305374
Name:MEDICAL SUPPLY SUPER CENTER
Entity Type:Organization
Organization Name:MEDICAL SUPPLY SUPER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AMIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-771-1315
Mailing Address - Street 1:55 SE 2ND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3615
Mailing Address - Country:US
Mailing Address - Phone:561-771-1713
Mailing Address - Fax:561-245-8563
Practice Address - Street 1:55 SE 2ND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3615
Practice Address - Country:US
Practice Address - Phone:561-771-1713
Practice Address - Fax:561-245-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies