Healthcare Provider Details

I. General information

NPI: 1609203512
Provider Name (Legal Business Name): SLADE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 43RD ST N SUITE 1403
PINELLAS PARK FL
33781-0906
US

IV. Provider business mailing address

6551 43RD ST N SUITE 1403
PINELLAS PARK FL
33781-0906
US

V. Phone/Fax

Practice location:
  • Phone: 727-525-0707
  • Fax: 727-526-1424
Mailing address:
  • Phone: 727-526-0707
  • Fax: 727-525-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEE
Title or Position: DIRECTOR
Credential:
Phone: 727-526-0707