1679689046 NPI number — DOCTORS MEDICAL RENTALS, CORP.

Table of content: MS. CHANTELLE EZINNE OKOYE LPC (NPI 1740986553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679689046 NPI number — DOCTORS MEDICAL RENTALS, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS MEDICAL RENTALS, CORP.
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:
1679689046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10418 NW 31ST TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-666-9911
Provider Business Mailing Address Fax Number:
305-666-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10418 NW 31ST TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33172-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-666-9911
Provider Business Practice Location Address Fax Number:
305-666-1601
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARDO
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
NELLO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-666-9911

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  HME508 , 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: 028697400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 672169996 . This is a "WAIVER, MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 672169998 WAIVER , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: R4276 . This is a "BC&BS PROVIDER NO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 672169979 WAIVER , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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