Provider Demographics
NPI:1043379134
Name:TOTAL CARE MEDICAL, INC.
Entity Type:Organization
Organization Name:TOTAL CARE MEDICAL, INC.
Other - Org Name:TOTAL HOMECARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:850-219-0202
Mailing Address - Street 1:PO BOX 14126
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4126
Mailing Address - Country:US
Mailing Address - Phone:850-219-0202
Mailing Address - Fax:850-219-0282
Practice Address - Street 1:2565 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4423
Practice Address - Country:US
Practice Address - Phone:850-219-0202
Practice Address - Fax:850-219-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18325332BX2000X, 3336C0003X, 3336C0004X
PH183253336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026677901Medicaid
FL1094844OtherPHARMACY NCPDP
FL026677900Medicaid
FLP8236OtherBCBS
FL026677900Medicaid