Provider Demographics
NPI:1578704318
Name:EXPRESS MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:EXPRESS MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-926-1400
Mailing Address - Street 1:195 PRATHER PARK DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7911
Mailing Address - Country:US
Mailing Address - Phone:843-236-4271
Mailing Address - Fax:
Practice Address - Street 1:195 PRATHER PARK DR
Practice Address - Street 2:UNIT 2
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7911
Practice Address - Country:US
Practice Address - Phone:843-236-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0271650002Medicare NSC