Provider Demographics
NPI:1710162912
Name:CUSTOM MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:CUSTOM MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOVESKY
Authorized Official - Suffix:
Authorized Official - Credentials:ATS
Authorized Official - Phone:941-722-3434
Mailing Address - Street 1:404 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5032
Mailing Address - Country:US
Mailing Address - Phone:941-722-3434
Mailing Address - Fax:
Practice Address - Street 1:404 10TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5032
Practice Address - Country:US
Practice Address - Phone:941-722-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL542332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL671444798OtherHOME & COMM. BASE WAIVER
FL686838079OtherBRAIN & SPINAL WAIVER
FL671444796OtherDEVELOPMT DISAB WAIVER
FL686628000OtherAGE & DIS PERSON WAIVER
FL028786500Medicaid
FL028786500Medicaid