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Organization
SCOFA LLC
Active
Organization
SCOFA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DACELIN ST MARTIN MD (OWNER)
(352) 527-6888
Entity
Organization
Contact information
Practice address
6405 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-9354
(352) 527-6888
Mailing address
6405 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-9354
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
09/15/2023
Last updated
09/15/2023
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