Healthcare Provider Details

I. General information

NPI: 1689656522
Provider Name (Legal Business Name): MED-SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 US HIGHWAY 431
BOAZ AL
35957-5905
US

IV. Provider business mailing address

406 MEDICAL CENTER DR
JASPER AL
35501-3400
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-0677
  • Fax: 256-593-0658
Mailing address:
  • Phone: 205-221-8200
  • Fax: 205-221-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number188
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number900493
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART H PACE
Title or Position: SR VICE PRESIDENT OF CORPORATE DEVE
Credential:
Phone: 205-414-7525