Organization
SUPREME HEALTHCARE SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IVAN E RUIZ-OTERO (OWNER)
(305) 859-3350
Entity
Organization
Contact information
Practice address
1035 NE 125TH ST, 301, NORTH MIAMI, FL 33161-5820
(305) 859-3350
(305) 928-2535
Mailing address
1035 NE 125TH ST, 301, NORTH MIAMI, FL 33161-5820
(305) 859-3350
(305) 928-2535
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
PED218
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7544650001
MEDICARE PTAN
FL
Enumeration date
07/29/2014
Last updated
09/13/2016
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