MEDICARE: ISRAEL EQUIPMENT CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255090817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISRAEL EQUIPMENT CORP

Provider Business Mailing Address
First Line	:	777 NW 72ND AVE STE 2099B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3182
Country	:	US
Telephone Number	:	786-547-9357
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 NW 72ND AVE STE 2099B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3182
Country	:	US
Telephone Number	:	786-547-9357
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISRAEL E RIVAS
Credential	:
Telephone Number	:	786-547-9357

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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