Provider Demographics
NPI:1457044406
Name:SEVENTEEN MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:SEVENTEEN MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEIXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-985-3152
Mailing Address - Street 1:6801 LAKE WORTH RD STE 126
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2971
Mailing Address - Country:US
Mailing Address - Phone:561-408-4324
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD STE 126
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2971
Practice Address - Country:US
Practice Address - Phone:561-408-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies