Provider Demographics
NPI:1760593495
Name:SOUTHERN HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-265-4271
Mailing Address - Street 1:PO BOX 2124
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-2124
Mailing Address - Country:US
Mailing Address - Phone:732-531-6875
Mailing Address - Fax:732-531-3593
Practice Address - Street 1:1445 N CONGRESS AVE
Practice Address - Street 2:SUITE 11 & 12
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6380
Practice Address - Country:US
Practice Address - Phone:561-265-4271
Practice Address - Fax:561-423-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313044332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5676100001Medicare NSC