Provider Demographics
NPI:1962681221
Name:KRYSTAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:KRYSTAL MEDICAL SERVICES
Other - Org Name:SAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENEDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-773-1355
Mailing Address - Street 1:7511 NW 73RD ST
Mailing Address - Street 2:104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2403
Mailing Address - Country:US
Mailing Address - Phone:305-889-0310
Mailing Address - Fax:305-889-1168
Practice Address - Street 1:7511 NW 73RD ST
Practice Address - Street 2:104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2403
Practice Address - Country:US
Practice Address - Phone:305-889-0310
Practice Address - Fax:305-889-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0888450002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0888450002Medicare NSC