Provider Demographics
NPI:1477589968
Name:CORPUS CHRISTI MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:CORPUS CHRISTI MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-8271
Mailing Address - Street 1:215 SW 17TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3689
Mailing Address - Country:US
Mailing Address - Phone:305-649-8271
Mailing Address - Fax:305-649-6988
Practice Address - Street 1:215 SW 17TH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3689
Practice Address - Country:US
Practice Address - Phone:305-649-8271
Practice Address - Fax:305-649-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312083332B00000X
FL3203663332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1312083OtherAHCA
FL3203663OtherOXYGEN
FL1312083OtherAHCA