Provider Demographics
NPI:1316211139
Name:JESSE L NELSON IRRV TR AGREEMENT
Entity Type:Organization
Organization Name:JESSE L NELSON IRRV TR AGREEMENT
Other - Org Name:BUDDY BIKE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MKTG & BSA DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-489-2453
Mailing Address - Street 1:2775 SUNNY ISLES BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4078
Mailing Address - Country:US
Mailing Address - Phone:786-489-2453
Mailing Address - Fax:
Practice Address - Street 1:2775 SUNNY ISLES BLVD STE 118
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4078
Practice Address - Country:US
Practice Address - Phone:786-489-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies