Provider Demographics
NPI:1295903789
Name:INDEPENDENCE SYSTEMS LLC
Entity type:Organization
Organization Name:INDEPENDENCE SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-257-6129
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-0575
Mailing Address - Country:US
Mailing Address - Phone:228-257-6129
Mailing Address - Fax:863-588-1594
Practice Address - Street 1:908 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4008
Practice Address - Country:US
Practice Address - Phone:228-257-6129
Practice Address - Fax:863-588-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000123055332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies