Provider Demographics
NPI:1104252493
Name:PALM BEACH COUNTY MEDICAL SUPPLY
Entity type:Organization
Organization Name:PALM BEACH COUNTY MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COF/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:888-686-0011
Mailing Address - Street 1:2393 S CONGRESS AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7628
Mailing Address - Country:US
Mailing Address - Phone:888-686-0011
Mailing Address - Fax:877-849-9990
Practice Address - Street 1:2393 S CONGRESS AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7628
Practice Address - Country:US
Practice Address - Phone:888-686-0011
Practice Address - Fax:877-849-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLORF153OtherORTHOTIC FITTER