South Medical Supply and Equipment LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

0062174 Issued in TX

Legal business name

SOUTH MEDICAL SUPPLY AND EQUIPMENT LLC

Practice address

6523 Duck Creek Dr # B
Garland, TX 75043-3644

Phone

(972) 303-7602

NPI assigned

Mar 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Loveth Isidaehomen

Title

Owner

Phone

(972) 303-7602

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1043339187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6523B DUCK CREEK DR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75043",
            "telephone_number": "972-303-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6523 DUCK CREEK DR # B",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750433644",
            "telephone_number": "972-303-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MEDICAL SUPPLY AND EQUIPMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "ISIDAEHOMEN",
        "authorized_official_first_name": "LOVETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-303-7602"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "TX",
            "license": "0062174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155295001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155295202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Spa Dental
• Lacie Spain, OT
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• Customized Equipment (DME) in Garland, TX
• Providers in Garland, TX by specialty
• Customized Equipment (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.