Provider Demographics
NPI:1699002477
Name:SOUTHERN MEDICAL-ADAPTIVE SOLUTIONS
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL-ADAPTIVE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DORR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-288-4641
Mailing Address - Street 1:1522 W. LINDBERG DRIVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8058
Mailing Address - Country:US
Mailing Address - Phone:985-288-4631
Mailing Address - Fax:985-288-4641
Practice Address - Street 1:1522 W. LINDBERG DRIVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8058
Practice Address - Country:US
Practice Address - Phone:985-288-4631
Practice Address - Fax:985-288-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1808725Medicaid
LA6403500001Medicare NSC