Provider Demographics
NPI:1629773395
Name:MUSC MEDICAL,LLC
Entity Type:Organization
Organization Name:MUSC MEDICAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:MUSCARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-236-7213
Mailing Address - Street 1:1903 S 25TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4740
Mailing Address - Country:US
Mailing Address - Phone:772-236-7213
Mailing Address - Fax:727-494-6715
Practice Address - Street 1:1903 S 25TH ST STE 105
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4740
Practice Address - Country:US
Practice Address - Phone:772-236-7213
Practice Address - Fax:727-494-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies