Provider Demographics
NPI:1538118518
Name:TABRAUE ORTHOPEDIC MEDICAL SUPPLY
Entity Type:Organization
Organization Name:TABRAUE ORTHOPEDIC MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABRAUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-4460
Mailing Address - Street 1:106 SW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2116
Mailing Address - Country:US
Mailing Address - Phone:305-649-4460
Mailing Address - Fax:305-649-9249
Practice Address - Street 1:106 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2116
Practice Address - Country:US
Practice Address - Phone:305-649-4460
Practice Address - Fax:305-649-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
FLORF189335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS10585OtherBOARD FRO ORTHOTIST/PROSTHETIST CERTIFICATION
FL2025OtherAHCA
FL028394100Medicaid
FL01995024OtherAMERIGROUP FLORIDA
FL693458796OtherMEDICAID WAIVER
FLM2813OtherBLUECROSS BLUESHIELD OF FLORIDA
FL323217OtherMEDICAL OXYGEN RETAILER
FLQMP000004742490OtherMOLINA
FLMCC600932603OtherMAGELLAN COMPLETE CARE
FL2025OtherAHCA