Provider Demographics
NPI:1992803027
Name:SOUTHERM MEDICAL AND EQUIPMENT SALES, L.P.
Entity type:Organization
Organization Name:SOUTHERM MEDICAL AND EQUIPMENT SALES, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-568-9945
Mailing Address - Street 1:4459 TARHEEL DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PINK HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28572
Mailing Address - Country:US
Mailing Address - Phone:252-568-9945
Mailing Address - Fax:252-568-3923
Practice Address - Street 1:4459 TARHEEL DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572
Practice Address - Country:US
Practice Address - Phone:252-568-9945
Practice Address - Fax:252-568-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01118332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01118OtherBOARD OF PHARMACY LIC
NC7704728Medicaid
NC5801270001Medicare NSC