Provider Demographics
NPI:1700815560
Name:PROFESSIONAL HEALTH CARE MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CARE MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LLAURADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-3611
Mailing Address - Street 1:7547 W 24TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6515
Mailing Address - Country:US
Mailing Address - Phone:305-556-3611
Mailing Address - Fax:305-574-8240
Practice Address - Street 1:7547 W 24TH AVE
Practice Address - Street 2:#200
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6515
Practice Address - Country:US
Practice Address - Phone:305-556-3611
Practice Address - Fax:305-574-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL625332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0855240001Medicare ID - Type Unspecified