MEDICARE: SOUTHEASTERN MED-SERVICE SPECIALISTS, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	327	FL

General Provider Information

NPI Number	:	1447210091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN MED-SERVICE SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	4390 SW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4406
Country	:	US
Telephone Number	:	305-264-2023
Fax Number	:	305-264-3535

Provider Business Practice Location Address
First Line	:	4390 SW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4406
Country	:	US
Telephone Number	:	305-264-2023
Fax Number	:	305-264-3535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT F. FOUNTAIN
Credential	:
Telephone Number	:	305-264-2023

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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