Southeastern DME LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOUTHEASTERN DME LLC

Practice address

200 S Indian River Dr Ste 300
Fort Pierce, FL 34950

Phone

(772) 460-6091

NPI assigned

Mar 27, 2018

Organization subpart

No

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

Authorized official

Name

Reinaldo Wilson

Title

Owner

Phone

(336) 740-0899

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1629573134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 JACKS CT",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313249344",
            "telephone_number": "336-740-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S INDIAN RIVER DR STE 300",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "34950",
            "telephone_number": "772-460-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN DME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-27",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "REINALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-740-0899"
    },
    "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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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.