Provider Demographics
NPI:1336371087
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:P.O. BOX 190
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:
Practice Address - Street 1:5941 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4043
Practice Address - Country:US
Practice Address - Phone:850-623-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURA-MED SOUTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies