Provider Demographics
NPI:1558336610
Name:MEDICAL EQUIPMENT & SUPPLIES
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEREIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-704-0955
Mailing Address - Street 1:V26 AVENIDA MUNOZ MARIN
Mailing Address - Street 2:URB MARIOLGA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6462
Mailing Address - Country:US
Mailing Address - Phone:787-704-0955
Mailing Address - Fax:787-704-0975
Practice Address - Street 1:V26 AVE MUNOZ MARIN
Practice Address - Street 2:URB MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6462
Practice Address - Country:US
Practice Address - Phone:787-704-0955
Practice Address - Fax:787-704-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4955390001332B00000X
332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFORM SS-4
PR4955390001Medicare NSC