Healthcare Provider Details

I. General information

NPI: 1972608719
Provider Name (Legal Business Name): SUNTREE MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 N WICKHAM RD STE 116
MELBOURNE FL
32940-8147
US

IV. Provider business mailing address

7640 N WICKHAM RD SUITE 116
MELBOURNE FL
32940-8146
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-3400
  • Fax: 321-253-3119
Mailing address:
  • Phone: 321-259-3400
  • Fax: 321-253-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH22488
License Number StateFL

VIII. Authorized Official

Name: DIAHN CLARK
Title or Position: OWNER
Credential:
Phone: 321-259-3400