Provider Demographics
NPI:1669578084
Name:SENIOR MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:SENIOR MEDICAL SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-536-7516
Mailing Address - Street 1:1967 LONGWOOD LAKE MARY RD STE 1007
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4673
Mailing Address - Country:US
Mailing Address - Phone:888-536-7516
Mailing Address - Fax:888-536-7517
Practice Address - Street 1:1967 LONGWOOD LAKE MARY RD STE 1007
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4673
Practice Address - Country:US
Practice Address - Phone:888-536-7516
Practice Address - Fax:888-536-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5676990001Medicare NSC