Provider Demographics
NPI:1205447034
Name:DIRECT MEDICAL SUPPLIES
Entity type:Organization
Organization Name:DIRECT MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LOIUES
Authorized Official - Last Name:DEZINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-993-9474
Mailing Address - Street 1:325 NW 130TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-3707
Mailing Address - Country:US
Mailing Address - Phone:305-993-9474
Mailing Address - Fax:
Practice Address - Street 1:325 NW 130TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-3707
Practice Address - Country:US
Practice Address - Phone:305-993-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies