Provider Demographics
NPI:1366881724
Name:1ST CHOICE ORTHOPEDIC SUPPLY LLC
Entity type:Organization
Organization Name:1ST CHOICE ORTHOPEDIC SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:LAZARA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-255-9070
Mailing Address - Street 1:13270 SW 131 ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-255-9070
Mailing Address - Fax:305-255-9071
Practice Address - Street 1:13270 SW 131ST ST
Practice Address - Street 2:SUITE 132
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5874
Practice Address - Country:US
Practice Address - Phone:305-255-9070
Practice Address - Fax:305-255-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7433490335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6969760001Medicare NSC