Provider Demographics
NPI:1578511887
Name:COLONA'S MEDICAL SUPPLY
Entity Type:Organization
Organization Name:COLONA'S MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICENTA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COLONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-591-3212
Mailing Address - Street 1:2500 NW 79TH AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1071
Mailing Address - Country:US
Mailing Address - Phone:305-591-3212
Mailing Address - Fax:305-591-3706
Practice Address - Street 1:2500 NW 79TH AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1071
Practice Address - Country:US
Practice Address - Phone:305-591-3212
Practice Address - Fax:305-591-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
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
FL5636760001Medicare ID - Type UnspecifiedPROVIDER NUMBER