Provider Demographics
NPI:1831178441
Name:MAXMED INC
Entity type:Organization
Organization Name:MAXMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:305-556-3510
Mailing Address - Street 1:5769 NW 151ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2483
Mailing Address - Country:US
Mailing Address - Phone:305-556-3510
Mailing Address - Fax:305-556-2792
Practice Address - Street 1:5769 NW 151ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2483
Practice Address - Country:US
Practice Address - Phone:305-556-3510
Practice Address - Fax:305-556-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20676096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107729Medicare ID - Type UnspecifiedPROVIDER NUMBER