Healthcare Provider Details

I. General information

NPI: 1821457920
Provider Name (Legal Business Name): SRW INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 S OCEAN BLVD F3
BOCA RATON FL
33432-7749
US

IV. Provider business mailing address

1299 S OCEAN BLVD F3
BOCA RATON FL
33432-7749
US

V. Phone/Fax

Practice location:
  • Phone: 443-253-2489
  • Fax:
Mailing address:
  • Phone: 443-253-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY GEORGE STASTNY
Title or Position: MANAGING PARTNER
Credential:
Phone: 443-253-2489