1952456071 NPI number — MILA MEDICAL SUPPLIES, INC.

Table of content: (NPI 1952456071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952456071 NPI number — MILA MEDICAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILA MEDICAL SUPPLIES, 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:
MILA MEDICAL SUPPLIES & FARMACY, INC.
Provider Other Organization Name Type Code:
4
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:
1952456071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1646 W 38TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-7026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-819-9175
Provider Business Mailing Address Fax Number:
305-819-9177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1646 W 38TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-7026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-819-9175
Provider Business Practice Location Address Fax Number:
305-819-9177
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ
Authorized Official First Name:
LIUDMILA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-819-9175

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1312095 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PH22804 , 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: PH 22804 . This is a "PHARMACY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 32-03682 . This is a "OXYGEN LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1312095 . This is a "HME STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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