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General NPI Number Information
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NPI Number | 1639270184
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Entity Type | Organization
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Legal Business Name | LILLYS DME MEDICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 175 FONTAINEBLEAU BLVD SUITE 1-N-3
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City | MIAMI
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State | FL
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Zip | 33172-7018
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Country | US
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Telephone | 786-439-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FONTAINEBLEAU BLVD SUITE 1-N-3
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City | MIAMI
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State | FL
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Zip | 33172-7018
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Country | US
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Telephone | 786-439-3228
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. OSVALDO HERNANDEZ
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Credential |
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Telephone | 786-439-3228
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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 | 1313141
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License Number State | FL
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