Provider Demographics
NPI:1821003401
Name:MEDICAL EQUIPMENT GROUP INC
Entity type:Organization
Organization Name:MEDICAL EQUIPMENT GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-964-8754
Mailing Address - Street 1:3109 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5148
Mailing Address - Country:US
Mailing Address - Phone:954-964-8754
Mailing Address - Fax:954-964-8764
Practice Address - Street 1:3109 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5148
Practice Address - Country:US
Practice Address - Phone:954-964-8754
Practice Address - Fax:954-964-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
FL3204164332BX2000X
FL1312519332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4505570001Medicare NSC