Southeastern Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOUTHEASTERN MEDICAL SUPPLY LLC

Practice address

120 N Laurel Ave
Corbin, KY 40701-1235

Phone

(606) 258-0001

Fax

(606) 258-0021

NPI assigned

Mar 16, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Barry Mahan

Title

Owner

Phone

(606) 258-0001

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southeastern Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Manchester, KY
  • NPI 1477335255

  0143420182

  Same PAC ID
• Southeastern Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Somerset, KY
  • NPI 1528658507

  0143420182

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Southeastern Medical Supply LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Southeastern Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Manchester, KY
  • NPI 1477335255
  NPD tax ID
• Southeastern Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Somerset, KY
  • NPI 1528658507
  NPD tax ID

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

{
    "created_epoch": "1205625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1437320686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1565",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407021565",
            "telephone_number": "606-258-0001",
            "fax_number": "606-258-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N LAUREL AVE",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407011235",
            "telephone_number": "606-258-0001",
            "fax_number": "606-258-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-16",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-258-0001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brittany Sparks, BCBA, LBA
• Karen Sue Sparks
• Tera Sparks

• Durable Medical Equipment & Medical Supplies in Corbin, KY
• Providers in Corbin, KY by specialty
• Durable Medical Equipment & Medical Supplies in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.