Provider Demographics
NPI:1194737403
Name:REDI MED LLC
Entity type:Organization
Organization Name:REDI MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-566-1226
Mailing Address - Street 1:4550 EXECUTIVE DR
Mailing Address - Street 2:#104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8805
Mailing Address - Country:US
Mailing Address - Phone:239-566-1226
Mailing Address - Fax:239-566-2519
Practice Address - Street 1:4550 EXECUTIVE DR
Practice Address - Street 2:#104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8805
Practice Address - Country:US
Practice Address - Phone:239-566-1226
Practice Address - Fax:239-566-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51538AOtherBC/BS
LA51538AOtherBC/BS