Healthcare Provider Details

I. General information

NPI: 1629183314
Provider Name (Legal Business Name): VIKING MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD AVE N
BIRMINGHAM AL
35203-1628
US

IV. Provider business mailing address

PO BOX 550309
BIRMINGHAM AL
35255-0309
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-8915
  • Fax: 205-278-6900
Mailing address:
  • Phone: 205-631-8915
  • Fax: 205-278-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number128
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number312
License Number StateAL

VIII. Authorized Official

Name: MR. LONNIE BLAKE DORCEY
Title or Position: OWNER/PRESIDENT
Credential: COF, RPT
Phone: 205-631-8915