Healthcare Provider Details

I. General information

NPI: 1699028357
Provider Name (Legal Business Name): SOUTH BUTLER MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MEETING STREET
GEORGIANA AL
36033-0723
US

IV. Provider business mailing address

P.O. BOX 735 435 MEETING STREET
GEORGIANA AL
36033-0723
US

V. Phone/Fax

Practice location:
  • Phone: 334-376-2286
  • Fax: 334-376-3661
Mailing address:
  • Phone: 334-376-2286
  • Fax: 334-376-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HARRY NMI COLE JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-376-2963