MEDICARE: NOVA LAB EQUIPMENT, CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1780691089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA LAB EQUIPMENT, CORP

Provider Business Mailing Address
First Line	:	9807 NW 80 AVE BAY 11 J
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	305-512-1385
Fax Number	:	305-512-1396

Provider Business Practice Location Address
First Line	:	9807 NW 80TH AVE UNIT 11J
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2325
Country	:	US
Telephone Number	:	305-512-1385
Fax Number	:	305-512-1396

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE A RODRIGUEZ
Credential	:
Telephone Number	:	305-512-1385

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/06/2007

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