Organization
PROFESSIONAL MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY EARL WAGNER RTS (PRESIDENT/CEO)
(772) 205-5408
Entity
Organization
Contact information
Practice address
101 N US HIGHWAY 1, SUITE 119, FORT PIERCE, FL 34950-4254
(772) 205-5408
Mailing address
101 N US HIGHWAY 1, SUITE 119, FORT PIERCE, FL 34950-4254
(772) 205-5408
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1312539
FL
Other
Enumeration date
07/08/2005
Last updated
12/02/2008
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