Provider Demographics
NPI:1609203512
Name:SLADE MEDICAL, INC.
Entity Type:Organization
Organization Name:SLADE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-526-0707
Mailing Address - Street 1:6551 43RD ST N
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-0906
Mailing Address - Country:US
Mailing Address - Phone:727-526-0707
Mailing Address - Fax:727-525-1424
Practice Address - Street 1:6551 43RD ST N
Practice Address - Street 2:SUITE 1403
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-0906
Practice Address - Country:US
Practice Address - Phone:727-525-0707
Practice Address - Fax:727-526-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier