Healthcare Provider Details

I. General information

NPI: 1265153670
Provider Name (Legal Business Name): FAMILY PROSTHETIC & MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BIG VALLEY DR STE A&B
ALEXANDRIA AL
36250-7004
US

IV. Provider business mailing address

111 BIG VALLEY DR STE A&B
ALEXANDRIA AL
36250-7004
US

V. Phone/Fax

Practice location:
  • Phone: 256-403-6344
  • Fax: 256-403-2459
Mailing address:
  • Phone: 256-403-6344
  • Fax: 256-403-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: SCOTTY DEWAYNE SAMS
Title or Position: OWNER/ PROSTHETIST
Credential: BOCP
Phone: 256-393-5183