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General NPI Number Information
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NPI Number | 1043495377
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Entity Type | Organization
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Legal Business Name | SOUTH EASTERN MEDICAL SUPLIES,INC
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Dates
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Enumeration Date | 01/06/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1307 E MILLBROOK RD SUITE C-23
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City | RALEIGH
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State | NC
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Zip | 27609-5476
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Country | US
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Telephone | 919-341-4468
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Fax | 919-341-2378
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Provider Business Mailing Address
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Address Line | 1307 E MILLBROOK RD SUITE C-23
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City | RALEIGH
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State | NC
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Zip | 27609-5476
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Country | US
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Telephone | 919-341-4468
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Fax | 919-341-2378
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Authorized Official
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Title or Position | DIRECTOR
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Name | EZUMA E ASI
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Credential | RN
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Telephone | 919-341-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 01375
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 01375
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 01375
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License Number State | NC
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