Provider Demographics
NPI:1649548363
Name:ULTRACARE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ULTRACARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDALITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-0700
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0844
Mailing Address - Country:US
Mailing Address - Phone:787-270-0700
Mailing Address - Fax:787-270-0706
Practice Address - Street 1:CARRETERA #2 KM 29.2 BARRIO ESPINOSA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-0700
Practice Address - Fax:787-270-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier