Healthcare Provider Details

I. General information

NPI: 1457391807
Provider Name (Legal Business Name): SOUTHERNCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 NW 63RD ST STE 200
OKLAHOMA CITY OK
73116-1547
US

IV. Provider business mailing address

3536 VANN RD
BIRMINGHAM AL
35235-3221
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-2722
  • Fax: 405-840-8460
Mailing address:
  • Phone: 205-655-4809
  • Fax: 205-655-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J PARDY
Title or Position: PRESIDENT
Credential:
Phone: 205-655-4809