Provider Demographics
NPI:1306967625
Name:MITCHCO LLC
Entity type:Organization
Organization Name:MITCHCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORPHIST
Authorized Official - Phone:941-359-3500
Mailing Address - Street 1:8313 LOCKWOOD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2930
Mailing Address - Country:US
Mailing Address - Phone:941-359-3500
Mailing Address - Fax:941-359-3554
Practice Address - Street 1:8313 LOCKWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2930
Practice Address - Country:US
Practice Address - Phone:941-359-3500
Practice Address - Fax:941-359-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20433332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5971910001Medicare NSC