MEDICARE: ALL SOUTHERN MEDICAL SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies	1312947	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1312947	OTHER	FL	HOME MEDICAL EQUIPMENT
2	R9985	OTHER	FL	BC & BS OF FLOIRDA

General Provider Information

NPI Number	:	1306803689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL SOUTHERN MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	2521 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5819
Country	:	US
Telephone Number	:	954-327-8094
Fax Number	:	954-327-8095

Provider Business Practice Location Address
First Line	:	2521 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5819
Country	:	US
Telephone Number	:	954-327-8094
Fax Number	:	954-327-8095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARLENE LYNN RUSSELL
Credential	:
Telephone Number	:	954-327-8094

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/19/2009

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