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General NPI Number Information
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NPI Number | 1427004944
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Entity Type | Organization
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Legal Business Name | SOUTHLAKE MEDICAL SUPPLIES, INC.
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 2140 E. SOUTHLAKE BLVD. #L-675
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6516
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Country | US
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Telephone | 817-319-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 E. SOUTHLAKE BLVD. #L-675
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6516
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Country | US
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Telephone | 817-319-8090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NANCY COZZIE
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Credential |
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Telephone | 817-319-8090
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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 | 0054467
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License Number State | TX
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