1922084698 NPI number — MIAMI DURABLE MEDICAL EQUIPMENT, INC.

Table of content: (NPI 1922084698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922084698 NPI number — MIAMI DURABLE MEDICAL EQUIPMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI DURABLE MEDICAL EQUIPMENT, 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:
RESTORE ORTHOTICS & PROSTHETICS
Provider Other Organization Name Type Code:
3
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:
1922084698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4699 SW 72ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-4540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-663-6446
Provider Business Mailing Address Fax Number:
305-663-5539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4699 SW 72ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-663-6446
Provider Business Practice Location Address Fax Number:
305-663-5539
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAMIREZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
305-663-6446

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  32 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 32 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 027554900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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