Organization
MEDIRECT LATINO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES W HANSEN III (CEO)
(954) 321-3540
Entity
Organization
Contact information
Practice address
2101 W ATLANTIC BLVD, SUITE # 101, POMPANO BEACH, FL 33069-2635
(954) 321-3540
(954) 321-3507
Mailing address
2101 W ATLANTIC BLVD, SUITE # 101, POMPANO BEACH, FL 33069-2635
(954) 321-3540
(954) 321-3507
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
FL
Enumeration date
08/01/2006
Last updated
07/23/2007
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