Healthcare Provider Details

I. General information

NPI: 1609822626
Provider Name (Legal Business Name): INDEPENDENT MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 2ND AVE NW
CULLMAN AL
35055-1706
US

IV. Provider business mailing address

1625 2ND AVE NW
CULLMAN AL
35055-1706
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-9171
  • Fax: 256-739-9356
Mailing address:
  • Phone: 256-739-9171
  • Fax: 256-739-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number368
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009605860
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier51031056IND
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBLUE CROSS PROVIDER NUMBE

VIII. Authorized Official

Name: MR. CARY ALAN NAIL
Title or Position: PRESIDENT
Credential:
Phone: 256-739-9171