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General NPI Number Information
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NPI Number | 1386679009
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 1024 WILDWOOD CENTRE DR SUITE A
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City | COLUMBIA
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State | SC
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Zip | 29229-8400
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Country | US
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Telephone | 803-233-3691
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Fax | 803-233-6140
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Provider Business Mailing Address
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Address Line | 1024 WILDWOOD CENTRE DR SUITE A
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City | COLUMBIA
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State | SC
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Zip | 29229-8400
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Country | US
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Telephone | 803-233-3691
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Fax | 803-233-6140
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Authorized Official
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Title or Position | SECRETARY/INSURANCE COORDINATOR
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Name | MR. MARY E NODELMAN
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Credential |
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Telephone | 803-233-3691
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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 | 1386679009
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License Number State | SC
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