Provider Demographics
NPI:1336758945
Name:CLEVELAND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:CLEVELAND MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-984-2814
Mailing Address - Street 1:1306 SE 46TH LN STE 1B
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8647
Mailing Address - Country:US
Mailing Address - Phone:239-984-2814
Mailing Address - Fax:239-984-2212
Practice Address - Street 1:1306 SE 46TH LN STE 1B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8647
Practice Address - Country:US
Practice Address - Phone:239-984-2814
Practice Address - Fax:239-984-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies