Healthcare Provider Details

I. General information

NPI: 1316028053
Provider Name (Legal Business Name): S A S B INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SW PARK ST
OKEECHOBEE FL
34972-4160
US

IV. Provider business mailing address

203 SW PARK ST
OKEECHOBEE FL
34972-4160
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-5100
  • Fax: 863-763-7550
Mailing address:
  • Phone: 863-763-5100
  • Fax: 863-763-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPH8238
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPH8238
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPH8238
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN D. NELSON
Title or Position: CEO - RPH.
Credential: RPH. - CRPH
Phone: 863-763-5100