Provider Demographics
NPI:1114172582
Name:SIGNATUREMEDICALSERVICES,LLC
Entity Type:Organization
Organization Name:SIGNATUREMEDICALSERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABEBAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-271-9620
Mailing Address - Street 1:619 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2283
Mailing Address - Country:US
Mailing Address - Phone:877-271-9620
Mailing Address - Fax:800-671-9167
Practice Address - Street 1:619 AVIS DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-2283
Practice Address - Country:US
Practice Address - Phone:877-271-9620
Practice Address - Fax:800-671-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22039332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies