Provider Demographics
NPI:1871214791
Name:SATELLITE MEDICAL SERVICES AND SUPPLY LLC
Entity type:Organization
Organization Name:SATELLITE MEDICAL SERVICES AND SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-269-6973
Mailing Address - Street 1:6741 CHURCH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2249
Mailing Address - Country:US
Mailing Address - Phone:470-278-2322
Mailing Address - Fax:
Practice Address - Street 1:6741 CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2249
Practice Address - Country:US
Practice Address - Phone:470-278-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies