Healthcare Provider Details

I. General information

NPI: 1871569129
Provider Name (Legal Business Name): DEEP SOUTH HOME MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SUNRISE LANE
MALVERN AL
36349
US

IV. Provider business mailing address

2233 E MAIN ST
MONTROSE CO
81401-3831
US

V. Phone/Fax

Practice location:
  • Phone: 334-671-0471
  • Fax:
Mailing address:
  • Phone: 970-765-0818
  • Fax: 970-497-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112249
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number065560
License Number StateAL

VIII. Authorized Official

Name: RICKY TODD FLOURNEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 334-671-9484