Provider Demographics
NPI:1366457947
Name:SOUTH KENDALL MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:SOUTH KENDALL MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-964-5971
Mailing Address - Street 1:10621 SW 88 ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-279-2585
Mailing Address - Fax:305-279-3280
Practice Address - Street 1:10621 SW 88 ST
Practice Address - Street 2:SUITE 122
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-279-2585
Practice Address - Fax:305-279-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312557332B00000X
332BP3500X
FL3203881332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5970410001Medicare NSC