Professional Medical Supply, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1312539 Issued in FL

Legal business name

PROFESSIONAL MEDICAL SUPPLY, INC.

Practice address

101 N US Highway 1
Suite 119
Fort Pierce, FL 34950-4254

Phone

(772) 205-5408

NPI assigned

Jul 8, 2005

Last updated

Dec 2, 2008By 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

Mr. Anthony Earl Wagner, RTS

Title

President/Ceo

Phone

(772) 205-5408

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1437157013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N US HIGHWAY 1",
            "address_2": "SUITE 119",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504254",
            "telephone_number": "772-205-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N US HIGHWAY 1",
            "address_2": "SUITE 119",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504254",
            "telephone_number": "772-205-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "772-205-5408",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RTS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "1312539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Fort Pierce, FL
• Providers in Fort Pierce, 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 Dec 2, 2008; 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.