Healthcare Provider Details

I. General information

NPI: 1568682078
Provider Name (Legal Business Name): AZALEA CITY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 DAUPHIN ISLAND PKWY
MOBILE AL
36605-3835
US

IV. Provider business mailing address

3046 DAUPHIN ISLAND PKWY
MOBILE AL
36605-3835
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-7067
  • Fax: 251-461-6439
Mailing address:
  • Phone: 251-287-7067
  • Fax: 251-461-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number111612
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number111612
License Number StateAL

VIII. Authorized Official

Name: DEBBIE KING
Title or Position: OWNERPRESIDENT
Credential:
Phone: 251-287-7067