Provider Demographics
NPI:1679518583
Name:SS & SUPPLY, INC.
Entity type:Organization
Organization Name:SS & SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-712-7200
Mailing Address - Street 1:501 S FALKENBURG RD STE D19
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8037
Mailing Address - Country:US
Mailing Address - Phone:813-712-7200
Mailing Address - Fax:813-712-7208
Practice Address - Street 1:501 S FALKENBURG RD STE D19
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8037
Practice Address - Country:US
Practice Address - Phone:813-712-7200
Practice Address - Fax:813-712-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02000088276332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032167200Medicaid
FL032167200Medicaid