Provider Demographics
NPI:1508394339
Name:SOUTHEAST MEDICAL, INC.
Entity Type:Organization
Organization Name:SOUTHEAST MEDICAL, INC.
Other - Org Name:ABC HOME MEDICAL SUPPLY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-897-8588
Mailing Address - Street 1:PO BOX 674553
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4553
Mailing Address - Country:US
Mailing Address - Phone:205-650-3260
Mailing Address - Fax:772-212-4904
Practice Address - Street 1:2117 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1539
Practice Address - Country:US
Practice Address - Phone:205-650-3260
Practice Address - Fax:772-212-4904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC HOME MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-24
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08836851Medicaid
AL242843Medicaid