MEDICARE: SOUTHEASTERN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578568176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	3615 CENTURY BLVD
Second Line	:	UNIT #1
City	:	LAKELAND
State	:	FL
Zip	:	33811
Country	:	US
Telephone Number	:	863-965-8856
Fax Number	:	863-551-1777

Provider Business Practice Location Address
First Line	:	3615 CENTURY BLVD
Second Line	:	UNIT #1
City	:	LAKELAND
State	:	FL
Zip	:	33811
Country	:	US
Telephone Number	:	863-965-8856
Fax Number	:	863-551-1777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELEANOR MARIE METHOT
Credential	:
Telephone Number	:	863-965-8856

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/28/2016

Similar Medicare Providers

1114885746 — DAVENE WALKER
Practice Location Address:

3301 MYSTIC POND LOOP
LAKELAND, FL
33811-2295

Practice Phone: 863-582-1321
Practice Fax:

1780674358 — SCOTT MARSHALL MOORE DC
Practice Location Address:

1701 SHEPHERD RD
LAKELAND, FL
33811-2179

Practice Phone: 863-646-5575
Practice Fax: 863-648-4465

1023090362 — SENIOR CARE PHARMACY OF FLORIDA LLC
Practice Location Address:

4175 S PIPKIN RD STE 208
LAKELAND, FL
33811-1699

Practice Phone: 863-577-1440
Practice Fax:

1639142839 — BRENDA MARGARET GIFFEN APRN
Practice Location Address:

4377 WHISTLEWOOD CIR
LAKELAND, FL
33811-3049

Practice Phone: 863-648-9573
Practice Fax:

1417924754 — TONY L. MOFFITT NP
Practice Location Address:

3810 DRANE FIELD RD , UNIT 15
LAKELAND, FL
33811-1204

Practice Phone: 863-646-8468
Practice Fax: 863-533-0333

1326096264 — MRS. AMY J FORT ARNP
Practice Location Address:

1426 LONGOAK DR S
LAKELAND, FL
33811-2115

Practice Phone: 863-640-7013
Practice Fax:

Directions to “SOUTHEASTERN MEDICAL SUPPLY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.