Healthcare Provider Details

I. General information

NPI: 1164518544
Provider Name (Legal Business Name): C & C MEDICAL EQUIPMENT & SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6043 NW 167TH ST SUITE A-16
MIAMI GARDENS FL
33015-4326
US

IV. Provider business mailing address

6043 NW 167TH ST SUITE A-16
MIAMI GARDENS FL
33015-4326
US

V. Phone/Fax

Practice location:
  • Phone: 305-392-9967
  • Fax: 305-392-9968
Mailing address:
  • Phone: 305-392-9967
  • Fax: 305-392-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number460
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3204502
License Number StateFL

VIII. Authorized Official

Name: NELIS BAHDER
Title or Position: PRESIDENT
Credential:
Phone: 954-663-1919