# CLEARWATER MEDICAL SUPPLY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023502184
- **Authorized official:** ANISOV VITALIV (OWNER)
- **Authorized official phone:** (727) 754-4341

## Contact information

- **Practice address:** 4707 140TH AVE N STE 312, CLEARWATER, FL 33762
- **Practice address phone:** (727) 754-4341
- **Mailing address:** 4707 140TH AVE N STE 312, CLEARWATER, FL 33762-3841
- **Mailing address phone:** (727) 754-4341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 06/21/2018
- **Last updated:** 03/02/2019