Provider Demographics
NPI:1356482699
Name:SIRIUS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SIRIUS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-449-2027
Mailing Address - Street 1:1300 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-6519
Mailing Address - Country:US
Mailing Address - Phone:727-449-2027
Mailing Address - Fax:727-469-8950
Practice Address - Street 1:1300 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-6519
Practice Address - Country:US
Practice Address - Phone:727-449-2027
Practice Address - Fax:727-469-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3868260001Medicare ID - Type UnspecifiedMEDICARE ID