MEDICARE: SOUTHERN HEALTHCARE SERVICES, LLC

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	1313044	FL

General Provider Information

NPI Number	:	1760593495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2124
Second Line	:
City	:	ASBURY PARK
State	:	NJ
Zip	:	07712-2124
Country	:	US
Telephone Number	:	732-531-6875
Fax Number	:	732-531-3593

Provider Business Practice Location Address
First Line	:	1445 N CONGRESS AVE
Second Line	:	SUITE 11 & 12
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6380
Country	:	US
Telephone Number	:	561-265-4271
Fax Number	:	561-423-0819

Authorized Official
Title or Position	:	PRESIDENT, OPERATIONS
Name	:	MICHAEL BOBRICK
Credential	:
Telephone Number	:	561-265-4271

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/26/2008

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