Healthcare Provider Details

I. General information

NPI: 1902150766
Provider Name (Legal Business Name): COOSA VALLEY RESPIRATORY & HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7044 ATLANTA HWY
MONTGOMERY AL
36117
US

IV. Provider business mailing address

7044 ATLANTA HIGHWAY
MONTGOMERY AL
36117
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-2729
  • Fax: 334-272-2705
Mailing address:
  • Phone: 334-272-2729
  • Fax: 334-272-2705

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 Number900567
License Number StateAL

VIII. Authorized Official

Name: THOMAS M FRANKLIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 205-221-8268