MEDICARE: SATELLITE MEDICAL SERVICES AND SUPPLY 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

General Provider Information

NPI Number	:	1871214791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SATELLITE MEDICAL SERVICES AND SUPPLY LLC

Provider Business Mailing Address
First Line	:	6741 CHURCH ST STE 3
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2249
Country	:	US
Telephone Number	:	470-278-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	6741 CHURCH ST STE 3
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2249
Country	:	US
Telephone Number	:	470-278-2322
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JAMES GORDON
Credential	:
Telephone Number	:	470-269-6973

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	12/27/2022

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