Provider Demographics
NPI:1821872326
Name:CENTRAL COMPOSITION INC
Entity type:Organization
Organization Name:CENTRAL COMPOSITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TIO FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-794-9040
Mailing Address - Street 1:412 E MADISON ST STE 1209E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4601
Mailing Address - Country:US
Mailing Address - Phone:813-302-0620
Mailing Address - Fax:
Practice Address - Street 1:412 E MADISON ST STE 1209E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4601
Practice Address - Country:US
Practice Address - Phone:813-302-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies