Healthcare Provider Details

I. General information

NPI: 1811930688
Provider Name (Legal Business Name): INFIRMARY HOME HEALTH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601B EMOGENE ST
MOBILE AL
36606-4806
US

IV. Provider business mailing address

420 W PINHOOK RD SUITE A
LAFAYETTE LA
70503-2131
US

V. Phone/Fax

Practice location:
  • Phone: 251-470-0170
  • Fax: 251-478-3671
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number201121
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number110694
License Number StateAL

VIII. Authorized Official

Name: MR. KEITH G. MYERS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 337-233-1307