Provider Demographics
NPI:1053848705
Name:COQUI MEDICAL SPECIALTIES
Entity Type:Organization
Organization Name:COQUI MEDICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-415-2255
Mailing Address - Street 1:832 SE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5610
Mailing Address - Country:US
Mailing Address - Phone:954-415-2255
Mailing Address - Fax:954-418-9631
Practice Address - Street 1:832 S.E. 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:954-415-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies