Healthcare Provider Details

I. General information

NPI: 1144325986
Provider Name (Legal Business Name): CERTIFIED MEDICAL SYSTEMS III INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 US HIGHWAY 1 S UNIT 1
ST AUGUSTINE FL
32086-6199
US

IV. Provider business mailing address

2600 US HIGHWAY 1 S UNIT 1
ST AUGUSTINE FL
32086-6199
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-9747
  • Fax: 904-810-9740
Mailing address:
  • Phone: 904-810-9747
  • Fax: 904-810-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1678
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL DILLMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 904-272-3022