Provider Demographics
NPI:1528191897
Name:ICON TECH SUPPLIES, INC.
Entity Type:Organization
Organization Name:ICON TECH SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEXY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-9835
Mailing Address - Street 1:8743 SW 9TH TER
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3235
Mailing Address - Country:US
Mailing Address - Phone:305-551-9835
Mailing Address - Fax:305-551-9836
Practice Address - Street 1:8743 SW 9TH TER
Practice Address - Street 2:SUITE 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3235
Practice Address - Country:US
Practice Address - Phone:305-551-9835
Practice Address - Fax:305-551-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDING PROVIDER #Medicare ID - Type UnspecifiedMEDICARE PROVIDER