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General NPI Number Information
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NPI Number | 1669655981
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Entity Type | Organization
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Legal Business Name | MIGUN OF THE BEACHES
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 363 ATLANTIC BLVD STE 12
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-5283
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Country | US
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Telephone | 904-242-0800
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Fax | 904-242-0800
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Provider Business Mailing Address
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Address Line | 363 ATLANTIC BLVD STE 12
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-5283
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Country | US
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Telephone | 904-242-0800
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Fax | 904-242-0800
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA A. FETTIG
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Credential | BS
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Telephone | 904-242-0800
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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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