Provider Demographics
NPI:1912942475
Name:EXPRESS MED MEDICAL SUPPLY CORP
Entity Type:Organization
Organization Name:EXPRESS MED MEDICAL SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-4140
Mailing Address - Street 1:3901 NW 79TH AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6554
Mailing Address - Country:US
Mailing Address - Phone:305-477-4140
Mailing Address - Fax:305-477-4160
Practice Address - Street 1:3901 NW 79TH AVE
Practice Address - Street 2:STE 220
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6554
Practice Address - Country:US
Practice Address - Phone:305-477-4140
Practice Address - Fax:305-477-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5513490001Medicare ID - Type Unspecified