# SOUTHLAKE MEDICAL SUPPLIES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427004944
- **Authorized official:** MS. NANCY COZZIE (PRESIDENT)
- **Authorized official phone:** (817) 319-8090

## Contact information

- **Practice address:** 2140 E. SOUTHLAKE BLVD., \#L-675, SOUTHLAKE, TX 76092-6516
- **Practice address phone:** (817) 319-8090
- **Mailing address:** 2140 E. SOUTHLAKE BLVD., \#L-675, SOUTHLAKE, TX 76092-6516
- **Mailing address phone:** (817) 319-8090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 0054467 | TX | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 09/22/2022