Healthcare Provider Details

I. General information

NPI: 1730540873
Provider Name (Legal Business Name): HYDE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 1ST AVE E
ONEONTA AL
35121-1407
US

IV. Provider business mailing address

PO BOX 107
ONEONTA AL
35121-0003
US

V. Phone/Fax

Practice location:
  • Phone: 205-625-6334
  • Fax: 205-625-6335
Mailing address:
  • Phone: 205-625-6334
  • Fax: 205-625-6335

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL WARDEN
Title or Position: OWNER
Credential:
Phone: 205-625-6334