Healthcare Provider Details

I. General information

NPI: 1164744439
Provider Name (Legal Business Name): MEDI-ONE SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 NE 1ST ST SUITE 515
MIAMI FL
33132-2515
US

IV. Provider business mailing address

261 NE 1ST ST SUITE 515
MIAMI FL
33132-2515
US

V. Phone/Fax

Practice location:
  • Phone: 646-648-0909
  • Fax: 305-274-0692
Mailing address:
  • Phone: 646-648-0909
  • Fax: 305-274-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name: ANTHONY RUMEO
Title or Position: MR
Credential:
Phone: 616-648-0909