Provider Demographics
NPI:1649307125
Name:OLYMPIC MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:OLYMPIC MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEPULVEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-817-1801
Mailing Address - Street 1:D8 CALLE MARGINAL
Mailing Address - Street 2:URB VISTA AZUL
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2539
Mailing Address - Country:US
Mailing Address - Phone:787-817-1801
Mailing Address - Fax:787-878-5666
Practice Address - Street 1:D8 CALLE MARGINAL
Practice Address - Street 2:URB VISTA AZUL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2539
Practice Address - Country:US
Practice Address - Phone:787-817-1801
Practice Address - Fax:787-878-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
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
PR1255880001Medicare NSC