Provider Demographics
NPI:1922417732
Name:EVIS MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:EVIS MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GISELLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MONCAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-296-3565
Mailing Address - Street 1:141 SOUTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1963
Mailing Address - Country:US
Mailing Address - Phone:860-296-3565
Mailing Address - Fax:860-296-3566
Practice Address - Street 1:348 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2526
Practice Address - Country:US
Practice Address - Phone:860-296-3565
Practice Address - Fax:860-296-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004143228Medicaid
CT004143228Medicaid