Southlake Medical Supplies, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0054467 Issued in TX

Legal business name

SOUTHLAKE MEDICAL SUPPLIES, INC.

Practice address

2140 E. Southlake Blvd.
#L-675
Southlake, TX 76092-6516

Phone

(817) 319-8090

NPI assigned

May 26, 2006

Last updated

Sep 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Nancy Cozzie

Title

President

Phone

(817) 319-8090

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1427004944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 E. SOUTHLAKE BLVD.",
            "address_2": "#L-675",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926516",
            "telephone_number": "817-319-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 E. SOUTHLAKE BLVD.",
            "address_2": "#L-675",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926516",
            "telephone_number": "817-319-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE MEDICAL SUPPLIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "COZZIE",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-319-8090",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0054467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143425002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143425001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southlake Health P.C.
• Southlake HK Group Health, LLC
• Southlake Hospice Care Inc
• Southlake Hospitalists LLC
• Southlake Kidney Specialists, PLLC
• Southlake Mhya PLLC (Medrein Health and Aesthetics)
• Southlake Natural Family Wellness, PLLC
• Southlake Neurology and
• Southlake Oncology
• Southlake Physical Medicine PLLC

• Durable Medical Equipment & Medical Supplies in Southlake, TX
• Providers in Southlake, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.