Provider Demographics
NPI:1922084698
Name:MIAMI DURABLE MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:MIAMI DURABLE MEDICAL EQUIPMENT, INC.
Other - Org Name:RESTORE ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-663-6446
Mailing Address - Street 1:4699 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4540
Mailing Address - Country:US
Mailing Address - Phone:305-663-6446
Mailing Address - Fax:305-663-5539
Practice Address - Street 1:4699 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4540
Practice Address - Country:US
Practice Address - Phone:305-663-6446
Practice Address - Fax:305-663-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027554900Medicaid
FL0709730001Medicare NSC