Provider Demographics
NPI:1548226137
Name:SUNCOAST MEDICARE SUPPLY CO. INC.
Entity type:Organization
Organization Name:SUNCOAST MEDICARE SUPPLY CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-821-7015
Mailing Address - Street 1:1145 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2858
Mailing Address - Country:US
Mailing Address - Phone:941-758-7768
Mailing Address - Fax:941-758-9881
Practice Address - Street 1:1145 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2858
Practice Address - Country:US
Practice Address - Phone:941-758-7768
Practice Address - Fax:941-758-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL212332B00000X, 332B00000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM0311OtherBLUE CROSS & BLUE SHIELD
FL10802402OtherCITRUS HEALTH CARE
FL080084OtherAVMED
0347460001Medicare NSC