Healthcare Provider Details

I. General information

NPI: 1053531145
Provider Name (Legal Business Name): DURA-MED SOUTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 HWY 113
FLOMATON AL
36441
US

IV. Provider business mailing address

PO BOX 1018
FLOMATON AL
36441-1018
US

V. Phone/Fax

Practice location:
  • Phone: 251-296-4224
  • Fax: 251-296-4226
Mailing address:
  • Phone: 251-296-4224
  • Fax: 251-296-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number748
License Number StateAL

VIII. Authorized Official

Name: JACK FLOYD
Title or Position: PRESIDENT
Credential:
Phone: 850-675-2448