Spark Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SPARK MEDICAL SUPPLY LLC

Practice address

3175 S Congress Ave Ste 305D
Palm Springs, FL 33461-2562

Phone

(561) 469-7980

NPI assigned

Jun 20, 2019

Last updated

Mar 12, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Nussbaum

Title

Owner

Phone

(561) 469-7980

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1083274112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 S CONGRESS AVE STE 305D",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334612562",
            "telephone_number": "561-469-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 S CONGRESS AVE STE 305D",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334612562",
            "telephone_number": "561-469-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "NUSSBAUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-469-7980"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Palm Springs, FL
• Providers in Palm Springs, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.