Provider Demographics
NPI:1386990141
Name:MARIANAS MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:MARIANAS MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENAVENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-483-2663
Mailing Address - Street 1:PO BOX 501877
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-1877
Mailing Address - Country:US
Mailing Address - Phone:670-233-6671
Mailing Address - Fax:670-233-6672
Practice Address - Street 1:PALE ARNOLD RD GUALO RAI
Practice Address - Street 2:M&H BUILDING
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-1877
Practice Address - Country:US
Practice Address - Phone:670-233-6671
Practice Address - Fax:670-233-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies