Provider Demographics
NPI:1669527339
Name:NORTH FLORIDA MEDICAL SALES AND RENTALS OF STARKE, INC.
Entity type:Organization
Organization Name:NORTH FLORIDA MEDICAL SALES AND RENTALS OF STARKE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SID
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-368-0202
Mailing Address - Street 1:407 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3925
Mailing Address - Country:US
Mailing Address - Phone:904-368-0202
Mailing Address - Fax:
Practice Address - Street 1:407 W MADISON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3925
Practice Address - Country:US
Practice Address - Phone:904-368-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313184332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1313184OtherAHCA HME AND SERVICES
FL326488OtherMEDICAL OXYGEN RETAILER