Provider Demographics
NPI:1639109010
Name:MEDICAL SHOPPE OF MARCO
Entity Type:Organization
Organization Name:MEDICAL SHOPPE OF MARCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LALONDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BS,ET
Authorized Official - Phone:239-389-4890
Mailing Address - Street 1:135 S BARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-5143
Mailing Address - Country:US
Mailing Address - Phone:239-389-4890
Mailing Address - Fax:239-389-4895
Practice Address - Street 1:135 S BARFIELD DR
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5143
Practice Address - Country:US
Practice Address - Phone:239-389-4890
Practice Address - Fax:239-389-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2180128740351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4913320001Medicare ID - Type UnspecifiedMEDICARE BILLING