1568513661 NPI number — MEDICAL EQUIPMENT SOLUTIONS OF SOUTHEAST FLORIDA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568513661 NPI number — MEDICAL EQUIPMENT SOLUTIONS OF SOUTHEAST FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EQUIPMENT SOLUTIONS OF SOUTHEAST FLORIDA, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1568513661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 JOHNNIE DODDS BLVD
Provider Second Line Business Mailing Address:
SUITE 161
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-2976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-236-5813
Provider Business Mailing Address Fax Number:
772-236-5815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 JOHNNIE DODDS BLVD
Provider Second Line Business Practice Location Address:
SUITE 161
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-2976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-236-5813
Provider Business Practice Location Address Fax Number:
772-236-5815
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KARLICK
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
VANCE
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
404-580-0262

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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