Provider Demographics
NPI:1386142800
Name:ALLSOURCE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ALLSOURCE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-766-4183
Mailing Address - Street 1:2901 W CYPRESS CREEK RD STE 102C
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1730
Mailing Address - Country:US
Mailing Address - Phone:954-766-4183
Mailing Address - Fax:
Practice Address - Street 1:2901 W CYPRESS CREEK RD STE 102C
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1730
Practice Address - Country:US
Practice Address - Phone:954-766-4183
Practice Address - Fax:954-734-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies