Provider Demographics
NPI:1013254929
Name:DURA-MED SOUTHEAST, INC
Entity Type:Organization
Organization Name:DURA-MED SOUTHEAST, INC
Other - Org Name:GREENLAWN HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-368-2424
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-0190
Mailing Address - Country:US
Mailing Address - Phone:850-675-2448
Mailing Address - Fax:850-675-3106
Practice Address - Street 1:810 E CRAIG ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-3071
Practice Address - Country:US
Practice Address - Phone:251-368-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies