Provider Demographics
NPI:1710925292
Name:RACCOONPOSSUM, INC.
Entity Type:Organization
Organization Name:RACCOONPOSSUM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MABIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-869-7323
Mailing Address - Street 1:100 ROCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4635
Mailing Address - Country:US
Mailing Address - Phone:407-869-7323
Mailing Address - Fax:
Practice Address - Street 1:100 ROCKINGHAM CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4635
Practice Address - Country:US
Practice Address - Phone:407-869-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies