Provider Demographics
NPI:1407801426
Name:ULTRA MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:ULTRA MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-2855
Mailing Address - Street 1:17601 NW 78TH AVE
Mailing Address - Street 2:102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3630
Mailing Address - Country:US
Mailing Address - Phone:305-820-2855
Mailing Address - Fax:305-820-1085
Practice Address - Street 1:17601 NW 78TH AVE
Practice Address - Street 2:102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3630
Practice Address - Country:US
Practice Address - Phone:305-820-2855
Practice Address - Fax:305-820-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21098333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1262070001Medicare ID - Type UnspecifiedPROVIDER NUMBER