Provider Demographics
NPI:1891788899
Name:PANTHER MEDICAL, INC.
Entity Type:Organization
Organization Name:PANTHER MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-639-9221
Mailing Address - Street 1:405 N REO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1060
Mailing Address - Country:US
Mailing Address - Phone:813-639-9221
Mailing Address - Fax:813-288-9838
Practice Address - Street 1:405 N REO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1060
Practice Address - Country:US
Practice Address - Phone:813-639-9221
Practice Address - Fax:813-288-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8510332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1181900001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER