Provider Demographics
NPI:1346306156
Name:SOUTHERN MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-372-2109
Mailing Address - Street 1:1150 PERIMETER PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0927
Mailing Address - Country:US
Mailing Address - Phone:931-372-2109
Mailing Address - Fax:931-372-2118
Practice Address - Street 1:1150 PERIMETER PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0927
Practice Address - Country:US
Practice Address - Phone:931-372-2109
Practice Address - Fax:931-372-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies