Healthcare Provider Details

I. General information

NPI: 1538188792
Provider Name (Legal Business Name): BRADENTON MEDICAL ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 GRAND BLVD
NEW PORT RICHEY FL
34652-5106
US

IV. Provider business mailing address

19559 NE 10TH AVE
N MIAMI BEACH FL
33179-3501
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-8385
  • Fax: 727-848-7943
Mailing address:
  • Phone: 305-651-3261
  • Fax: 305-651-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ARTURO FERNANDEZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-651-3261