Provider Demographics
NPI:1124159728
Name:DURAMED MEDICAL SERVICES
Entity type:Organization
Organization Name:DURAMED MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BISHOP
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT REGISTERED RESPI
Authorized Official - Phone:850-973-8116
Mailing Address - Street 1:602 NE BLUE RIDGE LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:FL
Mailing Address - Zip Code:32059
Mailing Address - Country:US
Mailing Address - Phone:850-973-8116
Mailing Address - Fax:850-973-8118
Practice Address - Street 1:289 SW RANGE AVE
Practice Address - Street 2:STE D
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340
Practice Address - Country:US
Practice Address - Phone:850-973-8116
Practice Address - Fax:850-973-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4268293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1655OtherBCBS
FLV3152OtherBCBS
FLV3152OtherBCBS