Provider Demographics
NPI:1194828616
Name:SHENK ENTERPRISES LLC
Entity Type:Organization
Organization Name:SHENK ENTERPRISES LLC
Other - Org Name:VIENNA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SHENK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-753-1959
Mailing Address - Street 1:2836 ENTERPRISES RD
Mailing Address - Street 2:STE 5
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32725
Mailing Address - Country:US
Mailing Address - Phone:386-753-1959
Mailing Address - Fax:386-753-1949
Practice Address - Street 1:2836 ENTERPRISE RD
Practice Address - Street 2:STE 5
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5210
Practice Address - Country:US
Practice Address - Phone:386-753-1959
Practice Address - Fax:386-753-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5557100001Medicare NSC