Provider Demographics
NPI:1295745222
Name:OUTPATIENT MEDICAL SUPPLIES,LLC
Entity type:Organization
Organization Name:OUTPATIENT MEDICAL SUPPLIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OSWALD
Authorized Official - Last Name:HONORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-439-0142
Mailing Address - Street 1:7481 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4985
Mailing Address - Country:US
Mailing Address - Phone:954-572-2616
Mailing Address - Fax:954-572-6770
Practice Address - Street 1:7481 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-572-2616
Practice Address - Fax:954-572-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313022332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1313022OtherSTATE OF FL HME LICENCE
FL5760690001Medicare PIN
FL1313022OtherSTATE OF FL HME LICENCE