Provider Demographics
NPI:1164443016
Name:SEMINOLE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:SEMINOLE MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-788-2263
Mailing Address - Street 1:285 W CENTRAL PKWY
Mailing Address - Street 2:#1704
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2579
Mailing Address - Country:US
Mailing Address - Phone:407-788-2263
Mailing Address - Fax:407-788-3919
Practice Address - Street 1:285 W CENTRAL PKWY
Practice Address - Street 2:#1704
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2579
Practice Address - Country:US
Practice Address - Phone:407-788-2263
Practice Address - Fax:407-788-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3201689332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1132110001Medicare ID - Type Unspecified