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Javier Enrique Canahuati Escobar

Student in an Organized Health Care Education/Training Program

Student, Health Care

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

PECOS Enrollment

This provider is enrolled in PECOS as JAVIER CANAHUATI ESCOBA.

Based on the most recent information from CMS, provider Javier Enrique Canahuati Escobar is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:05 AM.

Profile Details

Provider ID
1164125050
Provider Type
Individual
Full Name
Canahuati Escobar, Javier Enrique
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
3/22/2023
Last Updated
3/22/2023

Contact Information

Practice Location

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

(843) 692-1118

Unlisted Fax

Mailing Location

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

(843) 692-1118

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer South Carolina

Javier Enrique Canahuati Escobar

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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