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General NPI Number Information
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NPI Number | 1104446723
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDICAL EQUIPMENT AND SUPPLIES LLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 4715 NW 157TH ST STE 210
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6425
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Country | US
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Telephone | 305-722-6637
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Fax |
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Provider Business Mailing Address
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Address Line | 5375 NW 159TH ST UNIT 5396
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City | MIAMI LAKES
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State | FL
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Zip | 33014-8564
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Country | US
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Telephone | 305-722-6637
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ROBERT ANTHONY RUBERTI
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Credential |
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Telephone | 305-722-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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