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General NPI Number Information
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NPI Number | 1013416155
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN BRACING LLC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 200 CAHABA PARK CIR STE 212
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City | BIRMINGHAM
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State | AL
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Zip | 35242-8115
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Country | US
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Telephone | 205-807-2251
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Fax | 205-582-9641
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Provider Business Mailing Address
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Address Line | 120 AUSTIN CIR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-7069
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Country | US
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Telephone | 205-807-2251
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES ERIC MCBRAYER
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Credential | ORTHOTIC FITTER
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Telephone | 205-807-2251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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