Provider Demographics
NPI:1962681445
Name:DECUBEX INCORPORATED
Entity Type:Organization
Organization Name:DECUBEX INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANCEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:904-213-0426
Mailing Address - Street 1:1025 BLANDING BLVD
Mailing Address - Street 2:UNIT 503
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7750
Mailing Address - Country:US
Mailing Address - Phone:904-213-0426
Mailing Address - Fax:904-276-2733
Practice Address - Street 1:7048 MIDWAY TER
Practice Address - Street 2:UNIT 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-4288
Practice Address - Country:US
Practice Address - Phone:352-680-9008
Practice Address - Fax:352-680-9009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECUBEX INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1022332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1346266632OtherNPI #
FL1346266632OtherNPI #