Provider Demographics
NPI:1336313493
Name:SUNCARE MEDICAL, INC.
Entity Type:Organization
Organization Name:SUNCARE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MARCKESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-344-9637
Mailing Address - Street 1:2965 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3236
Mailing Address - Country:US
Mailing Address - Phone:352-344-9637
Mailing Address - Fax:352-344-9681
Practice Address - Street 1:2965 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3236
Practice Address - Country:US
Practice Address - Phone:352-344-9637
Practice Address - Fax:352-344-9681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNCARE MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1462332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4041180002Medicare NSC