MEDICARE: SAINT SIMMONS SOUND MANAGEMENT COMPANY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	1-066-1880	GA
2	332BN1400X	Nursing Facility Supplies (DME)	1-066-1880	GA

General Provider Information

NPI Number	:	1114108586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT SIMMONS SOUND MANAGEMENT COMPANY INC

Provider Business Mailing Address
First Line	:	1321 WASHINGTON HIGHWAY
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669
Country	:	US
Telephone Number	:	706-486-2167
Fax Number	:	706-486-4022

Provider Business Practice Location Address
First Line	:	1321 WASHINGTON HIGHWAY
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669
Country	:	US
Telephone Number	:	706-486-2167
Fax Number	:	706-486-4022

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BEVERLY BOYER
Credential	:
Telephone Number	:	706-486-2167

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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