Provider Demographics
NPI:1124192356
Name:EAGLE PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:EAGLE PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-643-3661
Mailing Address - Street 1:4150 NW 7TH ST
Mailing Address - Street 2:205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5535
Mailing Address - Country:US
Mailing Address - Phone:305-643-3661
Mailing Address - Fax:305-643-3677
Practice Address - Street 1:4150 NW 7TH ST
Practice Address - Street 2:205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5535
Practice Address - Country:US
Practice Address - Phone:305-643-3661
Practice Address - Fax:305-643-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies