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General NPI Number Information
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NPI Number | 1447763578
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Entity Type | Organization
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Legal Business Name | REBUILD MEDICAL INC
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Dates
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Enumeration Date | 11/11/2017
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Last Update Date | 11/11/2017
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Provider Practice Location Address
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Address Line | 500 INTERSTATE PARK DR STE 532
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City | MONTGOMERY
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State | AL
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Zip | 36109-5487
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Country | US
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Telephone | 334-320-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 PRAIRIE LN
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City | MONTGOMERY
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State | AL
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Zip | 36117-3413
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Country | US
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Telephone | 334-320-5305
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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. BRIAN HUMPHREY
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Credential |
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Telephone | 334-320-5305
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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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