Provider Demographics
NPI:1508045105
Name:S & T MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:S & T MEDICAL SUPPLY INC.
Other - Org Name:SOUTHEAST MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROHOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-364-2600
Mailing Address - Street 1:11054 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7217
Mailing Address - Country:US
Mailing Address - Phone:561-364-2600
Mailing Address - Fax:561-364-2199
Practice Address - Street 1:11054 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-364-2600
Practice Address - Fax:561-364-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9769OtherBC/BS
FL031702100Medicaid
FL0317021 00OtherMEDICAID
FL0317021 00OtherMEDICAID