# PROFESSIONAL MEDICAL SUPPLY, INC.

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

## Provider details

- **NPI number:** 1437157013
- **Authorized official:** MR. ANTHONY EARL WAGNER RTS (PRESIDENT/CEO)
- **Authorized official phone:** (772) 205-5408

## Contact information

- **Practice address:** 101 N US HIGHWAY 1, SUITE 119, FORT PIERCE, FL 34950-4254
- **Practice address phone:** (772) 205-5408
- **Mailing address:** 101 N US HIGHWAY 1, SUITE 119, FORT PIERCE, FL 34950-4254
- **Mailing address phone:** (772) 205-5408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1312539 | FL | Yes |

## Other

- **Enumeration date:** 07/08/2005
- **Last updated:** 12/02/2008