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General NPI Number Information
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NPI Number | 1528658507
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 120 S HIGHWAY 27 STE 4
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City | SOMERSET
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State | KY
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Zip | 42501-1784
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Country | US
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Telephone | 606-679-0155
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Fax | 606-679-0088
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Provider Business Mailing Address
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Address Line | PO BOX 1565
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City | CORBIN
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State | KY
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Zip | 40702-1565
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Country | US
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Telephone | 606-258-0001
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Fax | 606-258-0021
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Authorized Official
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Title or Position | ASSISTANT
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Name | SARA MAHAN
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Credential |
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Telephone | 606-258-0001
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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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