Provider Demographics
NPI:1104441831
Name:MT MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:MT MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUENZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-843-6847
Mailing Address - Street 1:3350 NW 2ND AVE STE A34
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6678
Mailing Address - Country:US
Mailing Address - Phone:561-843-6847
Mailing Address - Fax:
Practice Address - Street 1:3350 NW 2ND AVE STE A34
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6678
Practice Address - Country:US
Practice Address - Phone:561-486-9346
Practice Address - Fax:561-486-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies