Provider Demographics
NPI:1588020804
Name:SOUTHERN MEDICAL
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-7150
Mailing Address - Street 1:19184 DR JOHN LAMBERT DR
Mailing Address - Street 2:STE. 104
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0935
Mailing Address - Country:US
Mailing Address - Phone:985-542-7150
Mailing Address - Fax:985-542-7155
Practice Address - Street 1:19184 DR JOHN LAMBERT DR
Practice Address - Street 2:STE. 104
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0935
Practice Address - Country:US
Practice Address - Phone:985-542-7150
Practice Address - Fax:985-542-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies