Provider Demographics
NPI:1790198505
Name:NATURE COAST MEDICAL SUPPLY
Entity type:Organization
Organization Name:NATURE COAST MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-221-5293
Mailing Address - Street 1:920 E HATHAWAY AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-6702
Mailing Address - Country:US
Mailing Address - Phone:352-221-5293
Mailing Address - Fax:
Practice Address - Street 1:920 E HATHAWAY AVE
Practice Address - Street 2:APT 3
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6702
Practice Address - Country:US
Practice Address - Phone:352-221-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies