Healthcare Provider Details

I. General information

NPI: 1417934688
Provider Name (Legal Business Name): MERCURY ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 49TH ST N
CLEARWATER FL
33762-4807
US

IV. Provider business mailing address

11300 49TH ST N
CLEARWATER FL
33762-4807
US

V. Phone/Fax

Practice location:
  • Phone: 727-573-7689
  • Fax: 727-456-1997
Mailing address:
  • Phone: 727-573-7689
  • Fax: 727-456-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. STANLEY G TANGALAKIS
Title or Position: CHAIRMAN / CEO
Credential:
Phone: 727-573-7689