MEDICARE: MOUNT SION MEDICAL EQUIPMENT, INC

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	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S16780	OTHER	FL	BOC
2	787	OTHER	FL	AHCA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	321711	OTHER	FL	OXYGEN RETAILER LICENSE

General Provider Information

NPI Number	:	1386609485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SION MEDICAL EQUIPMENT, INC

Provider Business Mailing Address
First Line	:	12587 NW 7TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2619
Country	:	US
Telephone Number	:	305-953-3530
Fax Number	:	305-953-3531

Provider Business Practice Location Address
First Line	:	12587 NW 7TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2619
Country	:	US
Telephone Number	:	305-953-3530
Fax Number	:	305-953-3531

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MANUEL FONSECA
Credential	:
Telephone Number	:	305-953-3530

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	04/27/2011

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