Provider Demographics
NPI:1386830024
Name:SUNNY SEAS MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:SUNNY SEAS MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-750-7201
Mailing Address - Street 1:224 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9502
Mailing Address - Country:US
Mailing Address - Phone:601-750-7201
Mailing Address - Fax:866-306-2581
Practice Address - Street 1:1519 COX ST
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2530
Practice Address - Country:US
Practice Address - Phone:601-750-7201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6036150001Medicare NSC