Provider Demographics
NPI:1255802427
Name:TITAN MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:TITAN MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-306-6705
Mailing Address - Street 1:5400 S UNIVERSITY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5300
Mailing Address - Country:US
Mailing Address - Phone:954-306-6705
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR STE 110
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5300
Practice Address - Country:US
Practice Address - Phone:954-306-6705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies