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Organization
SPARK MEDICAL SUPPLY LLC
Active
Organization
SPARK MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NUSSBAUM (OWNER)
(561) 469-7980
Entity
Organization
Contact information
Practice address
3175 S CONGRESS AVE STE 305D, PALM SPRINGS, FL 33461-2562
(561) 469-7980
Mailing address
3175 S CONGRESS AVE STE 305D, PALM SPRINGS, FL 33461-2562
(561) 469-7980
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
06/20/2019
Last updated
03/12/2020
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