1619933348 NPI number — SUNCOAST MEDICARE SUPPLY CO. INC.

Table of content: (NPI 1619933348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619933348 NPI number — SUNCOAST MEDICARE SUPPLY CO. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST MEDICARE SUPPLY CO. 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:
1619933348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 TYRONE BLVD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33710-6332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-821-7015
Provider Business Mailing Address Fax Number:
727-894-6182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 49TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-6612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-821-7015
Provider Business Practice Location Address Fax Number:
727-894-6182
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALDWIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT CFO
Authorized Official Telephone Number:
727-821-7015

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  210 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 32:00281 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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