Provider Demographics
NPI:1881063451
Name:MEDICAL SUPPLIES FLA
Entity type:Organization
Organization Name:MEDICAL SUPPLIES FLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:INDEPENDENT
Authorized Official - Phone:727-479-5504
Mailing Address - Street 1:808 GRAND CENTRAL ST APT 12
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3451
Mailing Address - Country:US
Mailing Address - Phone:727-479-5504
Mailing Address - Fax:
Practice Address - Street 1:808 GRAND CENTRAL ST APT 12
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3451
Practice Address - Country:US
Practice Address - Phone:727-479-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBTR0034648332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies