Provider Demographics
NPI:1184657116
Name:MMA MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:MMA MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMARILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-290-9908
Mailing Address - Street 1:2450 SW 137TH AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8802
Mailing Address - Country:US
Mailing Address - Phone:305-221-3232
Mailing Address - Fax:305-221-3536
Practice Address - Street 1:2450 SW 137TH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8802
Practice Address - Country:US
Practice Address - Phone:305-221-3232
Practice Address - Fax:305-221-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BP3500X
FL32 02474332BX2000X
FL1294332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4069890001Medicare NSC