Organization
MERCURY ENTERPRISES, INC.
Active
Other names
MERCURY MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY G TANGALAKIS (CHAIRMAN / CEO)
(727) 573-7689
Entity
Organization
Contact information
Practice address
11300 49TH ST N, CLEARWATER, FL 33762-4807
(727) 573-7689
(727) 456-1997
Mailing address
11300 49TH ST N, CLEARWATER, FL 33762-4807
(727) 573-7689
(727) 456-1997
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027564600
—
FL
01
—
10481101
CITRUS HEALTH PLANS
—
01
—
202211
AMERIGROUP HEALTH PLANS
—
05
—
679647803
—
FL
05
—
679647896
—
FL
05
—
679647898
—
FL
01
—
R0247
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/28/2005
Last updated
04/29/2009
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