MEDICARE: SOUTHEAST MATERNAL 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	:	1811239619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MATERNAL MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	PO BOX 2036
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-2036
Country	:	US
Telephone Number	:	843-310-4650
Fax Number	:

Provider Business Practice Location Address
First Line	:	14323 OCEAN HWY
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-4817
Country	:	US
Telephone Number	:	832-310-4650
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JULEE KRECHEL
Credential	:
Telephone Number	:	843-458-0643

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/18/2022

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