Healthcare Provider Details

I. General information

NPI: 1871770156
Provider Name (Legal Business Name): MED-SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 HWY. 78 E. STE. 100
JASPER AL
35501-3400
US

IV. Provider business mailing address

406 MEDICAL CENTER DR.
JASPER AL
35501-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-384-3626
  • Fax: 205-384-5526
Mailing address:
  • Phone: 205-221-8200
  • Fax: 205-221-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number080255
License Number StateAL

VIII. Authorized Official

Name: LISA J. WELLS
Title or Position: EXECUTIVE DIRECTOR
Credential: CPCD
Phone: 205-221-8258