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General NPI Number Information
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NPI Number | 1336156579
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Entity Type | Organization
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Legal Business Name | AVG MEDICAL SERV CORP
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5881 NW 151 ST 215
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City | MIAMI LAKES
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State | FL
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Zip | 33014
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Country | US
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Telephone | 305-512-5199
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Fax | 305-512-5198
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Provider Business Mailing Address
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Address Line | 5881 NW 151 ST 215
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2456
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Country | US
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Telephone | 305-512-5199
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Fax | 305-512-5198
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANA E MARTINEZ
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Credential |
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Telephone | 305-512-5199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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