Provider Demographics
NPI:1154469112
Name:KAYSER MEDICAL EQUIPMENT CORP
Entity Type:Organization
Organization Name:KAYSER MEDICAL EQUIPMENT CORP
Other - Org Name:PROHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-267-6733
Mailing Address - Street 1:8177 SW 40TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6746
Mailing Address - Country:US
Mailing Address - Phone:305-267-6733
Mailing Address - Fax:305-267-5122
Practice Address - Street 1:8177 SW 40TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6746
Practice Address - Country:US
Practice Address - Phone:305-267-6733
Practice Address - Fax:305-267-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH227653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095707OtherOTHER ID NUMBER
1025480001Medicare NSC