Provider Demographics
NPI:1861501819
Name:DURA-MED SOUTHEAST INC
Entity Type:Organization
Organization Name:DURA-MED SOUTHEAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-675-2448
Mailing Address - Street 1:5272 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1178
Mailing Address - Country:US
Mailing Address - Phone:850-675-2448
Mailing Address - Fax:850-675-3106
Practice Address - Street 1:5272 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1178
Practice Address - Country:US
Practice Address - Phone:850-675-2448
Practice Address - Fax:850-675-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL951087700Medicaid
FLR8207OtherJAYFL BLUE CROSS AND BLUE
FL951087700Medicaid