Provider Demographics
NPI:1063493294
Name:TEODULO EQUIPMENT @ ORTHOPEDIC SUPPLY, INC
Entity Type:Organization
Organization Name:TEODULO EQUIPMENT @ ORTHOPEDIC SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEODULO
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-5700
Mailing Address - Street 1:4355 W 16TH AVE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7666
Mailing Address - Country:US
Mailing Address - Phone:305-558-5700
Mailing Address - Fax:305-558-5085
Practice Address - Street 1:4355 W 16TH AVE
Practice Address - Street 2:SUITE 203B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7666
Practice Address - Country:US
Practice Address - Phone:305-558-5700
Practice Address - Fax:305-558-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32 02370332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3890750001Medicare NSC