=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952363996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOWELL ORTHOPEDIC APPLIANCES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2103 SW 27TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-859-9544
-----------------------------------------------------
Fax | 305-859-9947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2103 SW 27TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-859-9544
-----------------------------------------------------
Fax | 305-859-9947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. THOMAS GILBERTO DOWELL
-----------------------------------------------------
Credential | BOCPO,CFO
-----------------------------------------------------
Telephone | 305-859-9544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | ORF19
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------