Healthcare Provider Details

I. General information

NPI: 1881891802
Provider Name (Legal Business Name): ALICE P MCVAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WILSON AVE W
THOMASVILLE AL
36784-2029
US

IV. Provider business mailing address

480 WILSON AVE W
THOMASVILLE AL
36784-2029
US

V. Phone/Fax

Practice location:
  • Phone: 334-637-0100
  • Fax: 334-637-0099
Mailing address:
  • Phone: 334-637-0100
  • Fax: 334-637-0099

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 Number
License Number State

VIII. Authorized Official

Name: MS. ALICE P MCVAY
Title or Position: OWNER
Credential:
Phone: 251-275-3964