Provider Demographics
NPI:1144357856
Name:SECRETLY YOURS ENT INC
Entity type:Organization
Organization Name:SECRETLY YOURS ENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-694-5970
Mailing Address - Street 1:9121 N MILITARY TRAIL SUITE 105
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-694-5970
Mailing Address - Fax:561-694-5972
Practice Address - Street 1:9121 N MILITARY TRL STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5985
Practice Address - Country:US
Practice Address - Phone:561-694-5970
Practice Address - Fax:561-694-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4337440001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT