Provider Demographics
NPI:1124032198
Name:CAREMAX MEDICAL RESOURCES, LLC
Entity Type:Organization
Organization Name:CAREMAX MEDICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-910-1578
Mailing Address - Street 1:13111 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5910 BENJAMIN CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5240
Practice Address - Country:US
Practice Address - Phone:813-887-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312764332B00000X
FLPH19929333600000X
AL112679333600000X
CO5590333600000X
CT721333600000X
DEA9-0000676333600000X
ID1964MS333600000X
IN64000732A333600000X
IA3604333600000X
KS22-02344333600000X
KYFL1144333600000X
MDP04376333600000X
MI5301008460333600000X
IL333600000X
ME333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003348OtherNCPDP
TX580103Medicaid
AZ131252Medicaid
AZ131252Medicaid
FLBC8714823OtherDEA LICENSE
FLBC8714823OtherDEA LICENSE