Provider Demographics
NPI:1093809444
Name:EXCELLENCE MEDICAL SUPLY, INC
Entity Type:Organization
Organization Name:EXCELLENCE MEDICAL SUPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:
Authorized Official - First Name:ORDANYS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-291-6719
Mailing Address - Street 1:139 NE 1 ST
Mailing Address - Street 2:SUITE # PH 10
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132
Mailing Address - Country:US
Mailing Address - Phone:786-291-6719
Mailing Address - Fax:
Practice Address - Street 1:139 NE 1 ST
Practice Address - Street 2:SUITE # PH 10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132
Practice Address - Country:US
Practice Address - Phone:786-291-6719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies