Healthcare Provider Details

I. General information

NPI: 1629368071
Provider Name (Legal Business Name): PHYSICIAN'S SOURCE HOME MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BELLE CHASE CT. N
FAIRHOPE AL
36532
US

IV. Provider business mailing address

305 BELLE CHASE CT N
FAIRHOPE AL
36532-3842
US

V. Phone/Fax

Practice location:
  • Phone: 251-533-2269
  • Fax:
Mailing address:
  • Phone: 251-533-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MISS DAWN MARIE HOWELL
Title or Position: MANAGER
Credential:
Phone: 251-533-2269