Provider Demographics
NPI:1528658507
Name:SOUTHEASTERN MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:SOUTHEASTERN MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-258-0001
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1565
Mailing Address - Country:US
Mailing Address - Phone:606-258-0001
Mailing Address - Fax:606-258-0021
Practice Address - Street 1:120 S HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1784
Practice Address - Country:US
Practice Address - Phone:606-679-0155
Practice Address - Fax:606-679-0088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN MEDICAL SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies