Healthcare Provider Details

I. General information

NPI: 1326149451
Provider Name (Legal Business Name): CHALLENGER MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 CORAL WAY #205
MIAMI FL
33155-1466
US

IV. Provider business mailing address

7235 CORAL WAY #205
MIAMI FL
33155-1466
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-3420
  • Fax: 305-262-3421
Mailing address:
  • Phone: 305-262-3420
  • Fax: 305-262-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2202
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3203412
License Number StateFL

VIII. Authorized Official

Name: EUGENIO B GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-262-3420