Provider Demographics
NPI:1740392166
Name:PRO-MEDI EQUIPMENT CORPORATION INC
Entity Type:Organization
Organization Name:PRO-MEDI EQUIPMENT CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-242-0770
Mailing Address - Street 1:16205 SW 117TH AVE
Mailing Address - Street 2:UNIT 17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1618
Mailing Address - Country:US
Mailing Address - Phone:786-242-0770
Mailing Address - Fax:786-242-0107
Practice Address - Street 1:16205 SW 117TH AVE
Practice Address - Street 2:UNIT 17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1618
Practice Address - Country:US
Practice Address - Phone:786-242-0770
Practice Address - Fax:786-242-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5498840001Medicare NSC