Provider Demographics
NPI:1427222173
Name:SAVANNAH MEDICAL, LLC
Entity Type:Organization
Organization Name:SAVANNAH MEDICAL, LLC
Other - Org Name:SAVANNAH MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BLOODWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-376-8416
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:402 EAST MARKET ST
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-0232
Mailing Address - Country:US
Mailing Address - Phone:512-398-4436
Mailing Address - Fax:512-398-4437
Practice Address - Street 1:402 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2808
Practice Address - Country:US
Practice Address - Phone:512-398-4436
Practice Address - Fax:512-398-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093062332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies