Provider Demographics
NPI:1164518544
Name:C & C MEDICAL EQUIPMENT & SUPPLY INC
Entity Type:Organization
Organization Name:C & C MEDICAL EQUIPMENT & SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-663-1919
Mailing Address - Street 1:6043 NW 167TH ST
Mailing Address - Street 2:SUITE A-16
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4326
Mailing Address - Country:US
Mailing Address - Phone:305-392-9967
Mailing Address - Fax:305-392-9968
Practice Address - Street 1:6043 NW 167TH ST
Practice Address - Street 2:SUITE A-16
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-4326
Practice Address - Country:US
Practice Address - Phone:305-392-9967
Practice Address - Fax:305-392-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL460332B00000X, 332BP3500X
FL3204502332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1303150001Medicare NSC