Healthcare Provider Details

I. General information

NPI: 1255667291
Provider Name (Legal Business Name): SECURITY MANAGEMENT AND INTEGRATION COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 E 29TH ST SUITE 317
TACOMA WA
98404-4008
US

IV. Provider business mailing address

1423 EAST 29TH ST SUITE 317
TACOMA WA
98404
US

V. Phone/Fax

Practice location:
  • Phone: 859-372-6618
  • Fax: 888-575-7414
Mailing address:
  • Phone: 859-372-6618
  • Fax: 888-575-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. CECIL AVERY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CISO, CISM
Phone: 859-372-6618