Provider Demographics
NPI:1629063623
Name:A-1 MASTECTOMY CARE, INC
Entity Type:Organization
Organization Name:A-1 MASTECTOMY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-515-0740
Mailing Address - Street 1:16608 SADDLE CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1808
Mailing Address - Country:US
Mailing Address - Phone:954-515-0740
Mailing Address - Fax:954-515-0260
Practice Address - Street 1:16608 SADDLE CLUB RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1808
Practice Address - Country:US
Practice Address - Phone:954-515-0740
Practice Address - Fax:954-515-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL296732OtherAVMED DME PROVIDER
FL002X6OtherPREFERRED HEALTH PARTNERS
FL0-50342OtherNEIGHBORHOOD DME PROVIDE
FL7565570OtherAETNA PPO PROVIDER
FL3647669OtherAETNA HMO PROVIDER
FLR9553OtherBLUE CROSS BLUE SHIELD DM
FL245123OtherWELLCARE DME PROVIDER
FL=========OtherUNITED DME PROVIDER
FLR9553OtherBLUE CROSS BLUE SHIELD DM
FL=========OtherUNITED DME PROVIDER