Provider Demographics
NPI:1730989716
Name:PROLENCE MEDICAL SUPPLIES & EQUIPMENTS LLC
Entity type:Organization
Organization Name:PROLENCE MEDICAL SUPPLIES & EQUIPMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-865-6623
Mailing Address - Street 1:5233 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6302
Mailing Address - Country:US
Mailing Address - Phone:954-533-3291
Mailing Address - Fax:954-533-4805
Practice Address - Street 1:5233 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6302
Practice Address - Country:US
Practice Address - Phone:954-533-3291
Practice Address - Fax:954-533-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies