MEDICARE: SOUTHEAST MEDICAL SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1313444	FL

General Provider Information

NPI Number	:	1932366556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MEDICAL SERVICES, INC

Provider Business Mailing Address
First Line	:	280 WEKIVA SPRINGS RD STE 2000
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6098
Country	:	US
Telephone Number	:	800-404-9761
Fax Number	:	888-404-9762

Provider Business Practice Location Address
First Line	:	280 WEKIVA SPRINGS RD STE 2000
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6098
Country	:	US
Telephone Number	:	800-404-9761
Fax Number	:	888-404-9762

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. EILEEN N SALEM
Credential	:
Telephone Number	:	800-404-9761

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	01/29/2019

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