Provider Demographics
NPI:1093720807
Name:PROFESSIONAL MEDICAL EQUIPMENT & SUPPLY INC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL EQUIPMENT & SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-252-1234
Mailing Address - Street 1:26059 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6613
Mailing Address - Country:US
Mailing Address - Phone:305-258-4020
Mailing Address - Fax:305-258-4034
Practice Address - Street 1:26059 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6613
Practice Address - Country:US
Practice Address - Phone:305-258-4020
Practice Address - Fax:305-258-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24209332B00000X, 332BX2000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4424610001Medicare NSC