Provider Demographics
NPI:1144325986
Name:CERTIFIED MEDICAL SYSTEMS III INC
Entity type:Organization
Organization Name:CERTIFIED MEDICAL SYSTEMS III INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-3022
Mailing Address - Street 1:2600 US HIGHWAY 1 S
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6199
Mailing Address - Country:US
Mailing Address - Phone:904-810-9747
Mailing Address - Fax:904-810-9740
Practice Address - Street 1:2600 US HIGHWAY 1 S
Practice Address - Street 2:UNIT 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6199
Practice Address - Country:US
Practice Address - Phone:904-810-9747
Practice Address - Fax:904-810-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1678332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025575100Medicaid
FL025575100Medicaid