Provider Demographics
NPI:1447210091
Name:SOUTHEASTERN MED-SERVICE SPECIALISTS, INC.
Entity type:Organization
Organization Name:SOUTHEASTERN MED-SERVICE SPECIALISTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-264-2023
Mailing Address - Street 1:4390 SW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4406
Mailing Address - Country:US
Mailing Address - Phone:305-264-2023
Mailing Address - Fax:305-264-3535
Practice Address - Street 1:4390 SW 74TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4406
Practice Address - Country:US
Practice Address - Phone:305-264-2023
Practice Address - Fax:305-264-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL327332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1213610001Medicare ID - Type UnspecifiedPROVIDER NUMBER