Provider Demographics
NPI:1417934688
Name:MERCURY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:MERCURY ENTERPRISES, INC.
Other - Org Name:MERCURY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TANGALAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-573-7689
Mailing Address - Street 1:11300 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4807
Mailing Address - Country:US
Mailing Address - Phone:727-573-7689
Mailing Address - Fax:727-456-1997
Practice Address - Street 1:11300 49TH ST N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-4807
Practice Address - Country:US
Practice Address - Phone:727-573-7689
Practice Address - Fax:727-456-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
202211OtherAMERIGROUP HEALTH PLANS
FL679647803Medicaid
FLR0247OtherBLUE CROSS BLUE SHIELD
FL027564600Medicaid
10481101OtherCITRUS HEALTH PLANS
FL679647898Medicaid
FL679647896Medicaid
FL679647898Medicaid