Kissimmee Med Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

KISSIMMEE MED SUPPLY LLC

Practice address

111 E Monument Ave Unit 302
Kissimmee, FL 34741-5772

Phone

(800) 451-0064

Fax

(407) 710-1226

NPI assigned

Mar 7, 2022

Last updated

Mar 8, 2022By 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

Kadicha Williams

Title

Owner

Phone

(800) 451-0064

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Skybridge Med Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Kissimmee, FL
  • NPI 1366199481

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1841947033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E MONUMENT AVE UNIT 302",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415772",
            "telephone_number": "800-451-0064",
            "fax_number": "407-710-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E MONUMENT AVE UNIT 302",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415772",
            "telephone_number": "800-451-0064",
            "fax_number": "407-710-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISSIMMEE MED SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KADICHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-451-0064"
    },
    "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 Kissimmee, FL
• Providers in Kissimmee, 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 8, 2022; 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.