Provider Demographics
NPI:1841225182
Name:CERTIFIED MEDICAL SYSTEMS I, INC
Entity Type:Organization
Organization Name:CERTIFIED MEDICAL SYSTEMS I, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-3022
Mailing Address - Street 1:2141 LOCH RANE BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5723
Mailing Address - Country:US
Mailing Address - Phone:904-272-3022
Mailing Address - Fax:
Practice Address - Street 1:2141 LOCH RANE BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5723
Practice Address - Country:US
Practice Address - Phone:904-272-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-8012346099-6332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4994590001Medicare NSC