Provider Demographics
NPI:1770677866
Name:SOUTHERN MEDICAL EQUIPMENT,LLC
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL EQUIPMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:601-353-0072
Mailing Address - Street 1:1054 GREYMONT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2718
Mailing Address - Country:US
Mailing Address - Phone:601-353-0072
Mailing Address - Fax:601-353-6151
Practice Address - Street 1:1054 GREYMONT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2718
Practice Address - Country:US
Practice Address - Phone:601-353-0072
Practice Address - Fax:601-353-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5510030001Medicare ID - Type Unspecified
MS=========Medicare UPIN