Provider Demographics
NPI:1205013414
Name:CAMBO MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:CAMBO MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-419-1428
Mailing Address - Street 1:2231 NORTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8990
Mailing Address - Country:US
Mailing Address - Phone:863-419-1428
Mailing Address - Fax:863-419-1985
Practice Address - Street 1:2231 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8990
Practice Address - Country:US
Practice Address - Phone:863-419-1428
Practice Address - Fax:863-419-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40633Medicare PIN