Provider Demographics
NPI:1508306713
Name:S & S MEDICAL, LLC
Entity Type:Organization
Organization Name:S & S MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEIBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:812-251-2441
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0493
Mailing Address - Country:US
Mailing Address - Phone:812-234-4642
Mailing Address - Fax:812-234-7314
Practice Address - Street 1:324 BLACKMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2309
Practice Address - Country:US
Practice Address - Phone:812-234-4642
Practice Address - Fax:812-234-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001944A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP81128Medicare UPIN