Provider Demographics
NPI:1760485940
Name:FIRST RESPONSE MEDICAL CORP
Entity Type:Organization
Organization Name:FIRST RESPONSE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-412-9393
Mailing Address - Street 1:10240 SW 56TH ST
Mailing Address - Street 2:STE 112C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7070
Mailing Address - Country:US
Mailing Address - Phone:305-412-9393
Mailing Address - Fax:305-412-9394
Practice Address - Street 1:10240 SW 56TH ST
Practice Address - Street 2:STE 112C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7070
Practice Address - Country:US
Practice Address - Phone:305-412-9393
Practice Address - Fax:305-412-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01875332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211769OtherAMERIGROUP PROVIDER
FLR8891OtherBLUE CROSS PROVIDER
FL1229220001Medicare ID - Type UnspecifiedMEDICARE PROVIDER