# BLACK BAG CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Black Bag Medical Supply
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376611558
- **Authorized official:** MR. BRYAN BARNABAE (PRESIDENT)
- **Authorized official phone:** (954) 970-0004

## Contact information

- **Practice address:** 6822 NW 20TH AVE, FT LAUDERDALE, FL 33309-1513
- **Practice address phone:** (954) 970-0004
- **Practice address fax:** (954) 970-9580
- **Mailing address:** 6822 NW 20TH AVE, FT LAUDERDALE, FL 33309-1513
- **Mailing address phone:** (954) 970-0004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1312673 | FL | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 08/22/2020