Provider Demographics
NPI:1003396755
Name:LOCUST MEDICAL
Entity Type:Organization
Organization Name:LOCUST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-213-9997
Mailing Address - Street 1:2637 E ATLANTIC BLVD STE 43289
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4939
Mailing Address - Country:US
Mailing Address - Phone:817-609-4066
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6562
Practice Address - Country:US
Practice Address - Phone:817-609-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies