Healthcare Provider Details

I. General information

NPI: 1487708822
Provider Name (Legal Business Name): STANDSURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PATRICIA AVE
FRUITLAND PARK FL
34731-2208
US

IV. Provider business mailing address

600 PATRICIA AVE
FRUITLAND PARK FL
34731-2208
US

V. Phone/Fax

Practice location:
  • Phone: 352-348-7624
  • Fax:
Mailing address:
  • Phone: 352-348-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberPRO91
License Number StateFL

VIII. Authorized Official

Name: SCOTT ANDERSON
Title or Position: PRESIDENT & CLINICIAN
Credential: CP,LP,BSHSA
Phone: 352-348-7624