Provider Demographics
NPI:1669511457
Name:PROFESSIONAL CARE DME INC.
Entity Type:Organization
Organization Name:PROFESSIONAL CARE DME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-1210
Mailing Address - Street 1:7401 NW 7TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2945
Mailing Address - Country:US
Mailing Address - Phone:305-442-1210
Mailing Address - Fax:305-269-0662
Practice Address - Street 1:7401 NW 7TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2945
Practice Address - Country:US
Practice Address - Phone:305-442-1210
Practice Address - Fax:305-269-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL178332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0383540001Medicare ID - Type UnspecifiedPROVIDER NUMBER