Provider Demographics
NPI:1245333574
Name:SOUTH POINT MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:SOUTH POINT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-1179
Mailing Address - Street 1:101 SUNNYTOWN ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3862
Mailing Address - Country:US
Mailing Address - Phone:407-830-1179
Mailing Address - Fax:407-830-7775
Practice Address - Street 1:101 SUNNYTOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3862
Practice Address - Country:US
Practice Address - Phone:407-830-1179
Practice Address - Fax:407-830-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312566332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5354980002Medicare ID - Type Unspecified