Provider Demographics
NPI:1083635338
Name:SOUTHWEST MEDICAL EQUIPMENT & SUPPLIES INCORPORATED
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL EQUIPMENT & SUPPLIES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-574-6334
Mailing Address - Street 1:819 DEL PRADO BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990
Mailing Address - Country:US
Mailing Address - Phone:239-574-6334
Mailing Address - Fax:239-574-8081
Practice Address - Street 1:819 DEL PRADO BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-574-6334
Practice Address - Fax:239-574-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL427332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0683100001Medicare ID - Type Unspecified