Organization
SOUTHSIDE MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY A DOLES (BILLING MANAGER)
(585) 770-2281
Entity
Organization
Contact information
Practice address
1900 S. CLINTON AVE. STE 320, ROCHESTER, NY 14618-5719
(585) 271-7141
(585) 419-6163
Mailing address
1900 S. CLINTON AVE STE 320 ROCH. NY 14618, ROCHESTER, NY 14618-5719
(585) 271-7141
(585) 419-6163
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02742689
—
NY
01
—
182719GD
PREFERRED CARE
NY
01
—
7273762
AETNA HEALTH, INC
NY
05
—
84V
—
NY
01
—
P0170059SS
EXCELLUS BLUE CROSS
NY
Enumeration date
05/13/2006
Last updated
11/25/2014
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