| Organization Name: | SOUTHERN MEDICAL SUPPLY |
| NPI Number: | 1457697146 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAY BLANKENSHIP (OWNER) |
| Mailing Address: | 625 Kentucky 980 Scottsville |
| State: | KY US |
| Postal Code: | 42164 |
| Phone Number: | 2702393200 |
| Fax Number: | |
| NPI Enumeration Date: | 12/27/2012 |
| NPI Last Update Date: | 05/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | MG0842 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |