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General NPI Number Information
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NPI Number | 1922417732
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Entity Type | Organization
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Legal Business Name | EVIS MEDICAL EQUIPMENT INC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 348 N MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2526
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Country | US
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Telephone | 860-296-3565
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Fax | 860-296-3566
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Provider Business Mailing Address
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Address Line | 141 SOUTH ST STE A
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1963
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Country | US
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Telephone | 860-296-3565
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Fax | 860-296-3566
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | GISELLA P MONCAYO
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Credential |
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Telephone | 860-296-3565
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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 |
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License Number State | CT
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