Provider Demographics
NPI:1972266344
Name:SOUTHEAST MEDICAL SUPPLIES CENTER INC
Entity Type:Organization
Organization Name:SOUTHEAST MEDICAL SUPPLIES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:JAIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-713-0138
Mailing Address - Street 1:11601 BISCAYNE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3151
Mailing Address - Country:US
Mailing Address - Phone:786-332-2897
Mailing Address - Fax:786-334-6357
Practice Address - Street 1:11601 BISCAYNE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3151
Practice Address - Country:US
Practice Address - Phone:305-713-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies