Provider Demographics
NPI:1861437931
Name:SOTHSIDE MEDICAL SERVICE
Entity type:Organization
Organization Name:SOTHSIDE MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-3077
Mailing Address - Street 1:8199 NW 74TH AVE
Mailing Address - Street 2:8199
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7401
Mailing Address - Country:US
Mailing Address - Phone:305-863-3077
Mailing Address - Fax:305-863-3079
Practice Address - Street 1:8199 NW 74TH AVE
Practice Address - Street 2:8199
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7401
Practice Address - Country:US
Practice Address - Phone:305-863-3077
Practice Address - Fax:305-863-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1013260001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment