Healthcare Provider Details

I. General information

NPI: 1316369689
Provider Name (Legal Business Name): SOUTHEASTERN MEDICAL BROKERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAIN ST
COLUMBIA SC
29201-2159
US

IV. Provider business mailing address

1001 WALTON WAY
AUGUSTA GA
30901-2841
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-1133
  • Fax: 803-252-0814
Mailing address:
  • Phone: 706-855-8988
  • Fax: 706-855-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC SMITH
Title or Position: PRESIDENT
Credential:
Phone: 706-855-8988