Provider Demographics
NPI:1801170014
Name:HEALTHCARE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:HEALTHCARE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DE'ARIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:609-453-7704
Mailing Address - Street 1:7257 LEM TURNER RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3371
Mailing Address - Country:US
Mailing Address - Phone:904-379-4750
Mailing Address - Fax:904-551-2053
Practice Address - Street 1:7257 LEM TURNER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3371
Practice Address - Country:US
Practice Address - Phone:904-379-4750
Practice Address - Fax:904-551-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000041543332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies