=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679229785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POPE SHENOUDA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2022
-----------------------------------------------------
Last Update Date | 08/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2228 US HWY 19
-----------------------------------------------------
City | HOLIDAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34691-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-934-1300
-----------------------------------------------------
Fax | 727-934-1313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2228 US HIGHWAY 19
-----------------------------------------------------
City | HOLIDAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34691-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-934-1300
-----------------------------------------------------
Fax | 727-934-1313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GEORGE HANNA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-940-3521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------