Provider Demographics
NPI:1578742169
Name:SOUTH MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SOUTH MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PIRELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-515-5997
Mailing Address - Street 1:12912 SW 133RD CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5806
Mailing Address - Country:US
Mailing Address - Phone:305-232-7892
Mailing Address - Fax:305-232-7032
Practice Address - Street 1:12912 SW 133RD CT
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5806
Practice Address - Country:US
Practice Address - Phone:305-232-7892
Practice Address - Fax:305-232-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6094680001Medicare NSC