Provider Demographics
NPI:1891308805
Name:MCSHAN MEDICAL LLC
Entity Type:Organization
Organization Name:MCSHAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-297-5003
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:FL
Mailing Address - Zip Code:32768-0639
Mailing Address - Country:US
Mailing Address - Phone:321-297-5003
Mailing Address - Fax:321-256-5176
Practice Address - Street 1:2201 S BAY ST STE B
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6300
Practice Address - Country:US
Practice Address - Phone:321-297-5003
Practice Address - Fax:321-256-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies