Provider Demographics
NPI:1326322959
Name:SOUTHERN MEDICAL STAFFING, LLC
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-445-2035
Mailing Address - Street 1:1305 METRO DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3444
Mailing Address - Country:US
Mailing Address - Phone:318-445-2035
Mailing Address - Fax:318-445-2330
Practice Address - Street 1:1305 METRO DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3444
Practice Address - Country:US
Practice Address - Phone:318-445-2035
Practice Address - Fax:318-445-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5852826251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care