1962681445 NPI number — DECUBEX INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962681445 NPI number — DECUBEX INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECUBEX INCORPORATED
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:
1962681445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 BLANDING BLVD
Provider Second Line Business Mailing Address:
UNIT 503
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32065-7750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-213-0426
Provider Business Mailing Address Fax Number:
904-276-2733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7048 MIDWAY TER
Provider Second Line Business Practice Location Address:
UNIT 201
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34472-4288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-680-9008
Provider Business Practice Location Address Fax Number:
352-680-9009
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHANCEY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-213-0426

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1022 , 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: 1346266632 . This is a "NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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