Healthcare Provider Details

I. General information

NPI: 1245214006
Provider Name (Legal Business Name): EAST ALABAMA HOMEMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 PEPPERELL PKWY SUITE 2
OPELIKA AL
36801-5473
US

IV. Provider business mailing address

PO BOX 4043
OPELIKA AL
36803-4043
US

V. Phone/Fax

Practice location:
  • Phone: 334-741-7410
  • Fax: 334-742-0032
Mailing address:
  • Phone: 334-741-7410
  • Fax: 334-742-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number557
License Number StateAL

VIII. Authorized Official

Name: MR. DANIEL BRETT STOUTE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 337-500-1977