Provider Demographics
NPI:1477613289
Name:WEST KENDALL TEAM SERVICES CORP
Entity Type:Organization
Organization Name:WEST KENDALL TEAM SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-232-0628
Mailing Address - Street 1:12214 SW 131ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6481
Mailing Address - Country:US
Mailing Address - Phone:305-232-0628
Mailing Address - Fax:305-232-0865
Practice Address - Street 1:12214 SW 131ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6481
Practice Address - Country:US
Practice Address - Phone:305-232-0628
Practice Address - Fax:305-232-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNOT REQ 4 PROVIDER332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGN PROVIDER #Medicare ID - Type UnspecifiedMEDICARE PROVIDER