Provider Demographics
NPI:1417977927
Name:ISMAEL MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:ISMAEL MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-762-0044
Mailing Address - Street 1:AVE CAMPO RICO 861
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE CAMPO RICO 861
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-762-0044
Practice Address - Fax:787-768-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5610490001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5610490001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT