Provider Demographics
NPI:1629192315
Name:MEDICAL DECISION LLC
Entity type:Organization
Organization Name:MEDICAL DECISION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:954-772-1631
Mailing Address - Street 1:2890 W STATE ROAD 84
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4828
Mailing Address - Country:US
Mailing Address - Phone:954-772-1631
Mailing Address - Fax:954-772-1566
Practice Address - Street 1:2890 W STATE ROAD 84
Practice Address - Street 2:SUITE #102
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4828
Practice Address - Country:US
Practice Address - Phone:954-772-1631
Practice Address - Fax:954-772-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021631379Medicaid
FL679812896Medicaid
FL678001600Medicaid
FL679812898Medicaid
FL021631300Medicaid
FL679812896Medicaid