Healthcare Provider Details

I. General information

NPI: 1275554198
Provider Name (Legal Business Name): SOUTHERN MEDICAL PRODUCT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 HIGHWAY 17 SUITE 3
HELENA AL
35080-3513
US

IV. Provider business mailing address

5140 HIGHWAY 17 SUITE 3
HELENA AL
35080-3513
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-3824
  • Fax: 205-664-5367
Mailing address:
  • Phone: 205-664-3824
  • Fax: 205-664-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11596
License Number StateAL

VIII. Authorized Official

Name: MS. JESSICA KARR
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-664-3824