MEDICARE: SOUTHLAND 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

General Provider Information

NPI Number	:	1396263349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	10665 SW 190TH ST STE 3209
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-7654
Country	:	US
Telephone Number	:	786-732-4653
Fax Number	:

Provider Business Practice Location Address
First Line	:	10665 SW 190TH ST STE 3209
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-7654
Country	:	US
Telephone Number	:	786-732-4653
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAVIER PEREZ
Credential	:
Telephone Number	:	786-732-4653

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	07/21/2022

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