Provider Demographics
NPI:1780731240
Name:SOUTHERN MEDICAL EQUIPMENT, CORP
Entity type:Organization
Organization Name:SOUTHERN MEDICAL EQUIPMENT, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-739-5915
Mailing Address - Street 1:3002 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4002
Mailing Address - Country:US
Mailing Address - Phone:256-533-4454
Mailing Address - Fax:256-533-6931
Practice Address - Street 1:3002 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4002
Practice Address - Country:US
Practice Address - Phone:256-533-4454
Practice Address - Fax:256-533-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3888332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000103132Medicaid
AL51500888OtherBLUE CROSS OF ALABAMA
AL0135450002Medicare NSC