Southern Medical

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

SOUTHERN MEDICAL

Practice address

106 Free Hill Rd
Hendersonville, TN 37075-3495

Phone

(615) 822-8888

Fax

(615) 822-8280

NPI assigned

Nov 4, 2008

Organization subpart

No

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

Authorized official

Name

Amber Blakely

Title

Ceo/Owner

Phone

(615) 822-8888

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ED MEDICAL INC Former legal business name

Locations

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1376796300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 FREE HILL ROAD",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753495",
            "telephone_number": "615-822-8888",
            "fax_number": "615-822-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 FREE HILL RD",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753495",
            "telephone_number": "615-822-8888",
            "fax_number": "615-822-8280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "480 E Main St",
            "address_purpose": "LOCATION",
            "city": "Gallatin",
            "state": "TN",
            "postal_code": "370662969",
            "country_code": "US",
            "telephone_number": "615-575-5080",
            "fax_number": "615-575-5083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "BLAKELY",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "615-822-8888"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0000000444",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ED MEDICAL INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clyde O Southwell, MD
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• Customized Equipment (DME) in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Customized Equipment (DME) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; 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.