Mijares Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MIJARES MEDICAL SUPPLY LLC

Practice address

3276 Buford Dr Ste 104-333
Buford, GA 30519-5702

Phone

(404) 436-2070

Fax

(877) 548-2685

NPI assigned

Jul 22, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ruel Mijares Bautista Jr.

Title

Ceo

Phone

(404) 436-2070

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1023425014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3276 BUFORD DR STE 104-333",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305195702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3276 BUFORD DR STE 104-333",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305195702",
            "telephone_number": "404-436-2070",
            "fax_number": "877-548-2685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIJARES MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "RUEL",
        "authorized_official_middle_name": "MIJARES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-436-2070",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aimee Augusta Mesenburg, OD
• Jennifer Mest, MS
• Metro Imaging Buford
• Angela Cher Michael Fisher, OTR/L
• James P Michel
• Kevwe Miller Fakpor, NP
• Kathryn Miller
• Kelcie Nichole Miller, DO
• Liza Miller
• Kimberly Milliken

• Durable Medical Equipment & Medical Supplies in Buford, GA
• Providers in Buford, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.