Provider Demographics
NPI:1811918907
Name:SOUTHERNMOST MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SOUTHERNMOST MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-292-0545
Mailing Address - Street 1:6651 MALONEY AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6057
Mailing Address - Country:US
Mailing Address - Phone:305-292-0545
Mailing Address - Fax:
Practice Address - Street 1:6651 MALONEY AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6057
Practice Address - Country:US
Practice Address - Phone:305-292-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5740420001Medicare NSC