Provider Demographics
NPI:1346082104
Name:MEDICAL SUPPLY SOURCE LLC
Entity type:Organization
Organization Name:MEDICAL SUPPLY SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-324-9288
Mailing Address - Street 1:7518 BRINKWORTH LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3734
Mailing Address - Country:US
Mailing Address - Phone:561-324-9288
Mailing Address - Fax:
Practice Address - Street 1:14405 WALTERS RD STE 1014
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1493
Practice Address - Country:US
Practice Address - Phone:346-771-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies