Healthcare Provider Details

I. General information

NPI: 1619933348
Provider Name (Legal Business Name): SUNCOAST MEDICARE SUPPLY CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 49TH ST N
SAINT PETERSBURG FL
33710-6612
US

IV. Provider business mailing address

929 TYRONE BLVD N
SAINT PETERSBURG FL
33710-6332
US

V. Phone/Fax

Practice location:
  • Phone: 727-821-7015
  • Fax: 727-894-6182
Mailing address:
  • Phone: 727-821-7015
  • Fax: 727-894-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number210
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32:00281
License Number StateFL

VIII. Authorized Official

Name: MR. BARRY E BALDWIN
Title or Position: PRESIDENT CFO
Credential:
Phone: 727-821-7015