Provider Demographics
NPI:1508335662
Name:SOA MEDICAL PRODUCTS
Entity Type:Organization
Organization Name:SOA MEDICAL PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-784-7490
Mailing Address - Street 1:6416 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2818
Mailing Address - Country:US
Mailing Address - Phone:404-784-7490
Mailing Address - Fax:
Practice Address - Street 1:6416 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2818
Practice Address - Country:US
Practice Address - Phone:404-784-7490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies