Healthcare Provider Details

I. General information

NPI: 1033126123
Provider Name (Legal Business Name): AZALEA CITY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/03/2014
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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number111612
License Number StateAL

VIII. Authorized Official

Name: MS. DEBORAH KING
Title or Position: OWNER PRESIDENT
Credential:
Phone: 251-287-7067