=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154887644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SECURE MEDICAL PRODUCTS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2019
-----------------------------------------------------
Last Update Date | 06/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 SW 12TH AVE
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-767-9764
-----------------------------------------------------
Fax | 754-227-7664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 SW 12TH AVE
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-767-9764
-----------------------------------------------------
Fax | 754-227-7664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/ PRESIDENT
-----------------------------------------------------
Name | PAULINA LACS FRANCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-767-9764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------