Organization
SOUTH MEDICAL SUPPLY AND EQUIPMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOVETH ISIDAEHOMEN (OWNER)
(972) 303-7602
Entity
Organization
Contact information
Practice address
6523 DUCK CREEK DR # B, GARLAND, TX 75043-3644
(972) 303-7602
Mailing address
6523B DUCK CREEK DR, GARLAND, TX 75043
(972) 303-7602
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
0062174
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155295001
—
TX
05
—
155295202
—
TX
Enumeration date
03/28/2007
Last updated
01/14/2010
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