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General NPI Number Information
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NPI Number | 1205119146
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Entity Type | Organization
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Legal Business Name | STATESERV MEDICAL OF ALABAMA, LLC
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 269 LYON LN
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City | BIRMINGHAM
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State | AL
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Zip | 35211-6407
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Country | US
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Telephone | 205-290-1117
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Fax | 866-280-0415
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Provider Business Mailing Address
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Address Line | 1201 S. ALMA SCHOOL ROAD SUITE 4000
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City | MESA
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State | AZ
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Zip | 85210
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Country | US
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Telephone | 336-227-8030
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Fax | 336-227-3288
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Authorized Official
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Title or Position | COO
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Name | CHRISTOPHER ROODE
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Credential |
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Telephone | 877-633-7250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 900774
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1014
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License Number State | AL
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