Provider Demographics
NPI:1992836480
Name:ELK MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:ELK MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARIDAD
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-6506
Mailing Address - Street 1:1570 W 38TH PL
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7012
Mailing Address - Country:US
Mailing Address - Phone:305-362-6506
Mailing Address - Fax:305-362-6635
Practice Address - Street 1:1570 W 38TH PL
Practice Address - Street 2:SUITE 11
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7012
Practice Address - Country:US
Practice Address - Phone:305-362-6506
Practice Address - Fax:305-362-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING #332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5952990001Medicare NSC