1467741017 NPI number — CMC HEALTH CARE SUPPLIERS, 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 1467741017 NPI number — CMC HEALTH CARE SUPPLIERS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMC HEALTH CARE SUPPLIERS, 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:
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:
1467741017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8390 NW 53RD ST
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-7813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-639-2140
Provider Business Mailing Address Fax Number:
305-639-2141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8390 NW 53RD ST
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-7813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-639-2140
Provider Business Practice Location Address Fax Number:
305-639-2141
Provider Enumeration Date:
04/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ANZOLA
Authorized Official First Name:
ADRIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/GENERAL MANAGER
Authorized Official Telephone Number:
305-639-2140

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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