1588652002 NPI number — COMPLETE MEDICAL SUPPLIES, INC.

Table of content: (NPI 1588652002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588652002 NPI number — COMPLETE MEDICAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE MEDICAL SUPPLIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588652002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11971 NW 37TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-748-1977
Provider Business Mailing Address Fax Number:
877-748-1985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11971 NW 37TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-748-1977
Provider Business Practice Location Address Fax Number:
877-748-1985
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HETTINGER
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/ OWNER
Authorized Official Telephone Number:
877-748-1977

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0721816 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588652002 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300027875 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30027875 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 548264 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580288100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588652002 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588652002 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2178303 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100631250 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588652002 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3015340 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100096794 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1101614891A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588652002 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17134030 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500774457 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030810200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3124758 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000179349 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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