Provider Demographics
NPI:1457720575
Name:MEDICAL EQUIPMENT AND SUPPLIES OF AMERICA LLC
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT AND SUPPLIES OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-851-9880
Mailing Address - Street 1:11601 56TH CT N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-4805
Mailing Address - Country:US
Mailing Address - Phone:727-851-9880
Mailing Address - Fax:866-727-2399
Practice Address - Street 1:4301 FORTUNE PL
Practice Address - Street 2:SUITES H & J
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1510
Practice Address - Country:US
Practice Address - Phone:321-821-4535
Practice Address - Fax:866-727-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313895332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6675850001Medicare NSC