Provider Demographics
NPI:1346405966
Name:STARLIGHT MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:STARLIGHT MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-403-7597
Mailing Address - Street 1:6860 GULFPORT BLVD S STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2108
Mailing Address - Country:US
Mailing Address - Phone:727-828-0770
Mailing Address - Fax:727-549-1768
Practice Address - Street 1:6435 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8411
Practice Address - Country:US
Practice Address - Phone:727-828-0770
Practice Address - Fax:727-549-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies