Provider Demographics
NPI:1710067046
Name:GREEN LIGHT MEDICAL SERVICES CORP
Entity Type:Organization
Organization Name:GREEN LIGHT MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-7857
Mailing Address - Street 1:3006 NW 79TH AVE
Mailing Address - Street 2:#5
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1010
Mailing Address - Country:US
Mailing Address - Phone:305-463-7857
Mailing Address - Fax:305-463-7876
Practice Address - Street 1:3006 NW 79TH AVE
Practice Address - Street 2:#5
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1010
Practice Address - Country:US
Practice Address - Phone:305-463-7857
Practice Address - Fax:305-463-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6134928332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies