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General NPI Number Information
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NPI Number | 1295748853
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Entity Type | Organization
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Legal Business Name | PROMEDICS INC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6555 NW 36TH ST STE 215
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6978
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Country | US
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Telephone | 305-870-0284
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Fax | 305-870-0284
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Provider Business Mailing Address
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Address Line | 6555 NW 36TH ST STE 215
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6978
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Country | US
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Telephone | 305-870-0284
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Fax | 305-870-0284
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Authorized Official
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Title or Position | PRESIDENT
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Name | SURAHYMI SERRA
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Credential |
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Telephone | 305-870-0284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1313081
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License Number State | FL
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