Provider Demographics
NPI:1114132727
Name:BECKER MEDICAL
Entity Type:Organization
Organization Name:BECKER MEDICAL
Other - Org Name:BLUESKYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIBNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-822-0707
Mailing Address - Street 1:PO BOX 21441
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-4441
Mailing Address - Country:US
Mailing Address - Phone:941-822-0707
Mailing Address - Fax:941-847-0808
Practice Address - Street 1:1020 HONORE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3004
Practice Address - Country:US
Practice Address - Phone:941-822-0707
Practice Address - Fax:941-847-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313270332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR3940OtherBLUECROSSBLUESHIELDFL
FL5931130001Medicare NSC