Provider Demographics
NPI:1851695365
Name:PET RHINO INC
Entity Type:Organization
Organization Name:PET RHINO INC
Other - Org Name:CVI MEDICAL OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-908-5302
Mailing Address - Street 1:5008 W LINEBAUGH AVE
Mailing Address - Street 2:STE 9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5095
Mailing Address - Country:US
Mailing Address - Phone:813-908-5302
Mailing Address - Fax:813-908-7013
Practice Address - Street 1:5008 W LINEBAUGH AVE
Practice Address - Street 2:STE 9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5095
Practice Address - Country:US
Practice Address - Phone:813-908-5302
Practice Address - Fax:813-908-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313414332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032609700Medicaid
FLR001UOtherBCBSFL
FL6237140001Medicare PIN