Organization
LYMPHEDEMA CARE CENTER OF NORTH FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANELA MARTINEZ OTR/L, CLT, CKTP (PRESIDENT)
(904) 375-0830
Entity
Organization
Contact information
Practice address
8563 ARGYLE BUSINESS LOOP, SUITE #2, JACKSONVILLE, FL 32244-6668
(904) 375-0830
(877) 811-4031
Mailing address
8563 ARGYLE BUSINESS LOOP, SUITE #2, JACKSONVILLE, FL 32244-6668
(904) 375-0830
(877) 811-4031
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
OT11418
FL
332BC3200X
Customized Equipment (DME)
Primary
OT11418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9959348
AETNA
FL
01
—
Z173G
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
04/29/2010
Last updated
09/28/2011
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