Provider Demographics
NPI:1275513327
Name:NOVA MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:NOVA MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-320-5400
Mailing Address - Street 1:12319 SW 132ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6477
Mailing Address - Country:US
Mailing Address - Phone:305-253-6470
Mailing Address - Fax:305-253-6469
Practice Address - Street 1:12319 SW 132ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6477
Practice Address - Country:US
Practice Address - Phone:305-253-6470
Practice Address - Fax:305-253-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5373370001332B00000X
FL1312483332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9695OtherBLUE CROSS BLUE SHIELD
FLR9695OtherBLUE CROSS BLUE SHIELD