Provider Demographics
NPI:1316369689
Name:SOUTHEASTERN MEDICAL BROKERS, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL BROKERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-855-8988
Mailing Address - Street 1:1001 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2841
Mailing Address - Country:US
Mailing Address - Phone:706-855-8988
Mailing Address - Fax:706-855-8902
Practice Address - Street 1:2101 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2159
Practice Address - Country:US
Practice Address - Phone:803-799-1133
Practice Address - Fax:803-252-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies