Healthcare Provider Details

I. General information

NPI: 1205119146
Provider Name (Legal Business Name): STATESERV MEDICAL OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 LYON LN
BIRMINGHAM AL
35211-6407
US

IV. Provider business mailing address

1201 S. ALMA SCHOOL ROAD SUITE 4000
MESA AZ
85210
US

V. Phone/Fax

Practice location:
  • Phone: 205-290-1117
  • Fax: 866-280-0415
Mailing address:
  • Phone: 336-227-8030
  • Fax: 336-227-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1014
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number900774
License Number StateAL

VIII. Authorized Official

Name: CHRISTOPHER ROODE
Title or Position: COO
Credential:
Phone: 877-633-7250