Provider Demographics
NPI:1750330957
Name:INTERMED EQUIPMENT SUPPLIES
Entity type:Organization
Organization Name:INTERMED EQUIPMENT SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-871-4644
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:STE 224
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-871-4644
Mailing Address - Fax:305-825-3810
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:STE 224
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-871-4644
Practice Address - Fax:305-825-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies