1619465689 NPI number — ABACOA MEDICAL SUPPLIES INC

Table of content: (NPI 1619465689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619465689 NPI number — ABACOA MEDICAL SUPPLIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABACOA 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:
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:
1619465689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 NW BOCA RATON BLVD STE 213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-994-2302
Provider Business Mailing Address Fax Number:
888-204-4514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 NW BOCA RATON BLVD STE 213
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-994-2302
Provider Business Practice Location Address Fax Number:
888-204-4514
Provider Enumeration Date:
04/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DICKSON
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-994-2302

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 2018106632 , 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: 2177429 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2483871 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1616 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPC-0004670 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 10026761200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300019499 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500758565 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067848214 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0698636 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1480327 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200806460A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 435148 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53407334 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6710681 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100570080 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900017037 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0393111 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101491800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151768600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250572523 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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