=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033137567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PPMEDICALSERVICES,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6595NW 36ST SUITE109
-----------------------------------------------------
City | VIRGINIA GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-308-6159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6595 NW 36TH ST SUITE109
-----------------------------------------------------
City | VIRGINIA GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-308-6159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IVAN PERALTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-876-0076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------