Provider Demographics
NPI:1962829770
Name:SEMINOLE DME LLC
Entity Type:Organization
Organization Name:SEMINOLE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-346-6077
Mailing Address - Street 1:7400 ABERCORN ST
Mailing Address - Street 2:STE 705 /B273
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2447
Mailing Address - Country:US
Mailing Address - Phone:912-346-6077
Mailing Address - Fax:
Practice Address - Street 1:7400 ABERCORN ST
Practice Address - Street 2:STE 705 /B273
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2447
Practice Address - Country:US
Practice Address - Phone:912-346-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies