Provider Demographics
NPI:1801198841
Name:MANATEE MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:MANATEE MEDICAL MANAGEMENT
Other - Org Name:WOUND CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:HODD
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:888-331-3531
Mailing Address - Street 1:4519 GEORGE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7329
Mailing Address - Country:US
Mailing Address - Phone:888-331-3531
Mailing Address - Fax:888-498-3990
Practice Address - Street 1:4519 GEORGE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7329
Practice Address - Country:US
Practice Address - Phone:888-331-3531
Practice Address - Fax:888-498-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6529350001Medicare NSC