Provider Demographics
NPI:1841846623
Name:FIVESTAR MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:FIVESTAR MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:CLERVIL
Authorized Official - Last Name:CHERISTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-901-7427
Mailing Address - Street 1:2468 US HIGHWAY 441/27 STE 201
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-2149
Mailing Address - Country:US
Mailing Address - Phone:352-901-7427
Mailing Address - Fax:
Practice Address - Street 1:2468 US HIGHWAY 441/27 STE 201
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-2149
Practice Address - Country:US
Practice Address - Phone:352-901-7427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies