=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568416642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCUMED HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2006
-----------------------------------------------------
Last Update Date | 10/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4735 NORREL DR SUITE 125
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-655-3707
-----------------------------------------------------
Fax | 205-655-4247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3854 AMERICAN WAY SUITE A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-298-3548
-----------------------------------------------------
Fax | 225-295-9678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL KUSSEROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-292-2031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------