Provider Demographics
NPI:1619933348
Name:SUNCOAST MEDICARE SUPPLY CO. INC.
Entity Type:Organization
Organization Name:SUNCOAST MEDICARE SUPPLY CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-821-7015
Mailing Address - Street 1:929 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6332
Mailing Address - Country:US
Mailing Address - Phone:727-821-7015
Mailing Address - Fax:727-894-6182
Practice Address - Street 1:929 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6332
Practice Address - Country:US
Practice Address - Phone:727-821-7015
Practice Address - Fax:727-894-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL210332B00000X, 332B00000X
FL32:00281332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080084OtherAVMED
FLM0255OtherBLUE CROSS & BLUE SHIELD
FL10802401OtherCITRUS HEALTHCARE
FLM0255OtherBLUE CROSS & BLUE SHIELD