1669527339 NPI number — NORTH FLORIDA MEDICAL SALES AND RENTALS OF STARKE, INC.

Table of content: (NPI 1669527339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669527339 NPI number — NORTH FLORIDA MEDICAL SALES AND RENTALS OF STARKE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FLORIDA MEDICAL SALES AND RENTALS OF STARKE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669527339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 W MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STARKE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32091-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-368-0202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 W MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32091-3925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-368-0202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
SID
Authorized Official Middle Name:
DUANE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
904-368-0202

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1313184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1313184 . This is a "AHCA HME AND SERVICES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 326488 . This is a "MEDICAL OXYGEN RETAILER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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