Provider Demographics
NPI:1033009162
Name:MD MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:MD MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-901-5400
Mailing Address - Street 1:201 S 2ND ST STE 212
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4328
Mailing Address - Country:US
Mailing Address - Phone:305-901-5400
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND ST STE 212
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4328
Practice Address - Country:US
Practice Address - Phone:305-901-5400
Practice Address - Fax:305-901-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment