Provider Demographics
NPI:1215973243
Name:MULTIMED HOME CARE SUPPLY
Entity type:Organization
Organization Name:MULTIMED HOME CARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EDMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CMF CDF
Authorized Official - Phone:787-863-0931
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:PTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740
Mailing Address - Country:US
Mailing Address - Phone:787-863-0931
Mailing Address - Fax:787-860-5931
Practice Address - Street 1:CONQUISTADOR AVE
Practice Address - Street 2:#B-1 SUITE #2
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-0931
Practice Address - Fax:787-860-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0917680001Medicare ID - Type Unspecified