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General NPI Number Information
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NPI Number | 1265431928
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Entity Type | Organization
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Legal Business Name | SOUTHERN EXPRESS MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 125 CHURCH ST SUITE B
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City | GEORGIANA
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State | AL
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Zip | 36033
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Country | US
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Telephone | 334-376-0003
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Fax | 334-376-5777
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Provider Business Mailing Address
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Address Line | PO BOX 710
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City | GEORGIANA
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State | AL
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Zip | 36033
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Country | US
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Telephone | 334-376-0003
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Fax | 334-376-5777
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL BRUCE
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Credential |
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Telephone | 334-376-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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