Organization
MEDEQUIPMENT & SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIGUEL ACOSTA (PRESIDENT)
(920) 634-1332
Entity
Organization
Contact information
Practice address
2713 HUMBOLDT RD APT 6, GREEN BAY, WI 54311-8457
(920) 634-1332
Mailing address
2713 HUMBOLDT RD APT 6, GREEN BAY, WI 54311-8457
(920) 634-1332
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
03/11/2018
Last updated
03/11/2018
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