Healthcare Provider Details

I. General information

NPI: 1891771515
Provider Name (Legal Business Name): MED-SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206A OAK MOUNTAIN CIR
PELHAM AL
35124-1357
US

IV. Provider business mailing address

406 MEDICAL CENTER DR
JASPER AL
35501-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-982-5058
  • Fax: 205-982-6998
Mailing address:
  • Phone: 205-221-8200
  • Fax: 205-221-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number111939
License Number StateAL

VIII. Authorized Official

Name: MR. STEWART H PACE
Title or Position: SR VICE PRESIDENT OF CORPORATE DEVE
Credential:
Phone: 205-414-7525