Provider Demographics
NPI:1235735002
Name:MEDICAL EXPRESS DEPOT LLC
Entity Type:Organization
Organization Name:MEDICAL EXPRESS DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-704-2673
Mailing Address - Street 1:11240 S ORANGE BLOSSOM TRL # 11240
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9428
Mailing Address - Country:US
Mailing Address - Phone:407-704-2673
Mailing Address - Fax:407-704-2614
Practice Address - Street 1:11240 S ORANGE BLOSSOM TRL # 11240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9428
Practice Address - Country:US
Practice Address - Phone:407-704-2673
Practice Address - Fax:407-704-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies