Provider Demographics
NPI:1073500088
Name:THE MEDICINE CHEST INC
Entity type:Organization
Organization Name:THE MEDICINE CHEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERISFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-753-1877
Mailing Address - Street 1:910 OLD CAMP RD
Mailing Address - Street 2:BUILDING #170
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5604
Mailing Address - Country:US
Mailing Address - Phone:352-753-1877
Mailing Address - Fax:352-753-3755
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:BUILDING #170
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-753-1877
Practice Address - Fax:352-753-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 0016588332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1060821-00Medicaid
FL1060821-01Medicaid
FL1294970002Medicare NSC