Provider Demographics
NPI:1326045345
Name:THE MEDICARE SHOPPE INCORPORATED
Entity Type:Organization
Organization Name:THE MEDICARE SHOPPE INCORPORATED
Other - Org Name:THE MEDICARE SHOPPE.COM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED ORTHOTIST
Authorized Official - Phone:305-693-3544
Mailing Address - Street 1:3013 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3210
Mailing Address - Country:US
Mailing Address - Phone:305-693-3544
Mailing Address - Fax:305-693-3519
Practice Address - Street 1:3013 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3210
Practice Address - Country:US
Practice Address - Phone:305-693-3544
Practice Address - Fax:305-693-3519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1222810001332B00000X
FLPH16014333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1222810001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT