Southeastern Medical Brokers, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOUTHEASTERN MEDICAL BROKERS, INC.

Practice address

4490 Washington Rd Ste 16
Evans, GA 30809-5898

Phone

(706) 855-8988

Fax

(706) 855-8902

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Brian Byler, ATP, RTS

Title

Vice-President

Phone

(706) 855-8988

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Integrity Medical Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

Locations

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1801979596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4490 WASHINGTON RD STE 16",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308095898",
            "telephone_number": "706-855-8988",
            "fax_number": "706-855-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4490 WASHINGTON RD STE 16",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308095898",
            "telephone_number": "706-855-8988",
            "fax_number": "706-855-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL BROKERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "BYLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "706-855-8988",
        "authorized_official_credential": "ATP, RTS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703994050B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE2463",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52036372001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrity Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Integrity Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Evans, GA
• Providers in Evans, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.