Provider Demographics
NPI:1891399408
Name:EDDIE'S MED SUPPLY LLC
Entity Type:Organization
Organization Name:EDDIE'S MED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-7959
Mailing Address - Street 1:2500 NW 79TH AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1003
Mailing Address - Country:US
Mailing Address - Phone:305-898-9756
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1003
Practice Address - Country:US
Practice Address - Phone:305-898-9756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies