Provider Demographics
NPI:1336156579
Name:AVG MEDICAL SERV CORP
Entity Type:Organization
Organization Name:AVG MEDICAL SERV CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-5199
Mailing Address - Street 1:5881 NW 151 ST
Mailing Address - Street 2:215
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2456
Mailing Address - Country:US
Mailing Address - Phone:305-512-5199
Mailing Address - Fax:305-512-5198
Practice Address - Street 1:5881 NW 151 ST
Practice Address - Street 2:215
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-512-5199
Practice Address - Fax:305-512-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies