Provider Demographics
NPI:1700034162
Name:SOUTHEASTERN MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-846-0169
Mailing Address - Street 1:1010 19TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5227
Mailing Address - Country:US
Mailing Address - Phone:601-846-0169
Mailing Address - Fax:
Practice Address - Street 1:1010 19TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5227
Practice Address - Country:US
Practice Address - Phone:601-846-0169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies