Provider Demographics
NPI:1558325142
Name:SOUTHEAST MEDICAL & MOBILITY SUPPLY INC
Entity Type:Organization
Organization Name:SOUTHEAST MEDICAL & MOBILITY SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-304-1263
Mailing Address - Street 1:PO BOX 3472
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3472
Mailing Address - Country:US
Mailing Address - Phone:828-304-1263
Mailing Address - Fax:
Practice Address - Street 1:1620 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4244
Practice Address - Country:US
Practice Address - Phone:828-304-1263
Practice Address - Fax:828-304-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01396332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4438210001Medicare NSC