Supreme Healthcare Supply LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

PED218 Issued in FL

Legal business name

SUPREME HEALTHCARE SUPPLY LLC

Practice address

1035 NE 125TH St
301
North Miami, FL 33161-5820

Phone

(305) 859-3350

Fax

(305) 928-2535

NPI assigned

Jul 29, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Ivan E Ruiz-Otero

Title

Owner

Phone

(305) 859-3350

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1871901322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 NE 125TH ST",
            "address_2": "301",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615820",
            "telephone_number": "305-859-3350",
            "fax_number": "305-928-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 NE 125TH ST",
            "address_2": "301",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615820",
            "telephone_number": "305-859-3350",
            "fax_number": "305-928-2535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HEALTHCARE SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-29",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "RUIZ-OTERO",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-859-3350",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "FL",
            "license": "PED218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "7544650001",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in North Miami, FL
• Providers in North Miami, FL by specialty
• Customized Equipment (DME) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.