Provider Demographics
NPI:1386609485
Name:MOUNT SION MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:MOUNT SION MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-953-3530
Mailing Address - Street 1:12587 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2619
Mailing Address - Country:US
Mailing Address - Phone:305-953-3530
Mailing Address - Fax:305-953-3531
Practice Address - Street 1:12587 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2619
Practice Address - Country:US
Practice Address - Phone:305-953-3530
Practice Address - Fax:305-953-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS16780OtherBOC
FL787OtherAHCA
FL950981000Medicaid
FL321711OtherOXYGEN RETAILER LICENSE
FLS16780OtherBOC