Provider Demographics
NPI:1578568176
Name:SOUTHEASTERN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:METHOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-965-8856
Mailing Address - Street 1:3615 CENTURY BLVD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811
Mailing Address - Country:US
Mailing Address - Phone:863-965-8856
Mailing Address - Fax:863-551-1777
Practice Address - Street 1:3615 CENTURY BLVD
Practice Address - Street 2:UNIT #1
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811
Practice Address - Country:US
Practice Address - Phone:863-965-8856
Practice Address - Fax:863-551-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4638830001Medicare ID - Type UnspecifiedHME