1457396376 NPI number — MRB ACQUISITION CORP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457396376 NPI number — MRB ACQUISITION CORP

Employer Identification Number (EIN):

Provider Organization Name:

MRB ACQUISITION CORP

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

LINCARE POWERED MOBILITY

Provider Other Organization Name Type Code:

3

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:

1457396376

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/20/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

19387 US HIGHWAY 19 N

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CLEARWATER

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33764-3102

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

727-530-7700

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1898 S CLYDE MORRIS BLVD

Provider Second Line Business Practice Location Address:

SUITE 410

Provider Business Practice Location Address City Name:

DAYTONA BEACH

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32119-1584

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

866-387-2668

Provider Business Practice Location Address Fax Number:

386-254-2844

Provider Enumeration Date:

06/17/2006

Authorized Official Last Name:

MCCARTHY

Authorized Official First Name:

GREGORY

Authorized Official Middle Name:

Authorized Official Title or Position:

CHIEF OPERATIONS OFFICER

Authorized Official Telephone Number:

727-530-7700

• Taxonomy code: 332B00000X , with the licence number:  8519 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BX2000X , with the licence number: 32:04483 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 022929600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 121378400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1014691930001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 9266409 AND TAX ID . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 5607416 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 807182800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
• Identifier: 200070320A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: R9241 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 342165100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 027940 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: DE2695 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".