Provider Demographics
NPI:1821035965
Name:SANS SOUCI MEDICAL SERVICE, CORP.
Entity Type:Organization
Organization Name:SANS SOUCI MEDICAL SERVICE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-887-2056
Mailing Address - Street 1:8511 NW SOUTH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7426
Mailing Address - Country:US
Mailing Address - Phone:305-887-2056
Mailing Address - Fax:786-337-6440
Practice Address - Street 1:8511 NW SOUTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7426
Practice Address - Country:US
Practice Address - Phone:305-887-2056
Practice Address - Fax:786-337-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312847332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5660550001Medicare ID - Type Unspecified