MEDICARE: DURA MED SOUTHEAST, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	111970	AL
2	332BC3200X	Customized Equipment (DME)	111970	AL
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	111970	AL
4	332BX2000X	Oxygen Equipment & Supplies (DME)	111970	AL
5	333600000X	Pharmacy	111970	AL
6	3336C0003X	Community/Retail Pharmacy	111970	AL
7	3336H0001X	Home Infusion Therapy Pharmacy	111970	AL
8	3336L0003X	Long Term Care Pharmacy	111970	AL
9	3336M0002X	Mail Order Pharmacy	111970	AL
10	3336S0011X	Specialty Pharmacy	111970	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-05269	OTHER	AL	BCBS
2	16252100	OTHER		OWCP

General Provider Information

NPI Number	:	1679519854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURA MED SOUTHEAST, INC.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-0190
Country	:	US
Telephone Number	:	251-578-1333
Fax Number	:	251-578-1333

Provider Business Practice Location Address
First Line	:	100 E FRONT ST
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-2927
Country	:	US
Telephone Number	:	251-578-1333
Fax Number	:	251-578-1333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JACK R. FLOYD
Credential	:
Telephone Number	:	251-578-1333

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	09/11/2025

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