Provider Demographics
NPI:1497939268
Name:DECUBEX INCORPORATED
Entity Type:Organization
Organization Name:DECUBEX INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANCEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:904-213-0426
Mailing Address - Street 1:2717 N W ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-8400
Mailing Address - Country:US
Mailing Address - Phone:850-429-0383
Mailing Address - Fax:850-429-0367
Practice Address - Street 1:1025 BLANDING BLVD
Practice Address - Street 2:UNIT 503
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7750
Practice Address - Country:US
Practice Address - Phone:904-213-0426
Practice Address - Fax:904-276-2733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECUBEX INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1022332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1009230001Medicare PIN