1841879897 NPI number — FLEXIBLE MEDICAL SUPPLY INC

Table of content: MRS. JENNIFER ROSE LESAC RN, BSN (NPI 1134776792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841879897 NPI number — FLEXIBLE MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLEXIBLE MEDICAL SUPPLY 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:
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:
1841879897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4720 SE 15TH AVE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33904-9663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-800-5674
Provider Business Mailing Address Fax Number:
239-599-8769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4720 SE 15TH AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33904-9663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-800-5674
Provider Business Practice Location Address Fax Number:
239-599-8769
Provider Enumeration Date:
04/06/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEGRIN MARTINEZ
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-800-5674

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)