Provider Demographics
NPI:1053157230
Name:EVERGLADES MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:EVERGLADES MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-532-1740
Mailing Address - Street 1:750 E SAMPLE RD STE 2-206
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5136
Mailing Address - Country:US
Mailing Address - Phone:954-598-3010
Mailing Address - Fax:
Practice Address - Street 1:750 E SAMPLE RD STE 2-206
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5136
Practice Address - Country:US
Practice Address - Phone:954-532-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies