Provider Demographics
NPI:1427053321
Name:AMANDA MEDICAL
Entity type:Organization
Organization Name:AMANDA MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATP
Authorized Official - Phone:727-535-6100
Mailing Address - Street 1:3720 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3621
Mailing Address - Country:US
Mailing Address - Phone:727-535-6100
Mailing Address - Fax:727-535-6466
Practice Address - Street 1:3720 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3621
Practice Address - Country:US
Practice Address - Phone:727-535-6100
Practice Address - Fax:727-535-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1039332B00000X, 332BC3200X, 332BX2000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026266800Medicaid
FL3952490001Medicare NSC