Provider Demographics
NPI:1053531145
Name:DURA-MED SOUTHEAST, INC.
Entity type:Organization
Organization Name:DURA-MED SOUTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-675-2448
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-1018
Mailing Address - Country:US
Mailing Address - Phone:251-296-4224
Mailing Address - Fax:251-296-4226
Practice Address - Street 1:174 HWY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441
Practice Address - Country:US
Practice Address - Phone:251-296-4224
Practice Address - Fax:251-296-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL748332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031884101Medicaid
AL009935181Medicaid
FL031884101Medicaid