Provider Demographics
NPI:1013545359
Name:SOVR DISTRIBUTION NETWORK, LLC
Entity Type:Organization
Organization Name:SOVR DISTRIBUTION NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIMITE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-518-0974
Mailing Address - Street 1:11 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 W 36TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7146
Practice Address - Country:US
Practice Address - Phone:404-518-0974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies