Healthcare Provider Details

I. General information

NPI: 1942075056
Provider Name (Legal Business Name): TAMED MANE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 N BROWNLEE ST
BIRMINGHAM AL
35207-1100
US

IV. Provider business mailing address

PO BOX 280
FULTONDALE AL
35068-0280
US

V. Phone/Fax

Practice location:
  • Phone: 205-585-0086
  • Fax:
Mailing address:
  • Phone: 205-585-0086
  • Fax:

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 TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name: LATOYA L WHITE
Title or Position: LPN/ OWNER
Credential: LPN-CPS
Phone: 205-585-0086