Provider Demographics
NPI:1619920170
Name:JFK COMPLETE MEDICAL INC
Entity Type:Organization
Organization Name:JFK COMPLETE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAMILET
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-868-6104
Mailing Address - Street 1:777 NE 79TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4701
Mailing Address - Country:US
Mailing Address - Phone:305-759-7275
Mailing Address - Fax:305-759-7276
Practice Address - Street 1:777 NE 79TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4701
Practice Address - Country:US
Practice Address - Phone:305-759-7275
Practice Address - Fax:305-759-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5518020001Medicare NSC