1982657383 NPI number — EXCELLENT HOME MEDICAL EQUIPMENT CORP.

Table of content: (NPI 1982657383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982657383 NPI number — EXCELLENT HOME MEDICAL EQUIPMENT CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELLENT HOME MEDICAL EQUIPMENT 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:
1982657383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18555 SW 104TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUTLER BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157-6847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-382-0116
Provider Business Mailing Address Fax Number:
305-382-0129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9961 SW 142ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-6844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-382-0116
Provider Business Practice Location Address Fax Number:
305-382-0129
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOBARGANES
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-382-0116

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH28010 , 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: 1039177 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006481500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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