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General NPI Number Information
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NPI Number | 1578626669
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Entity Type | Organization
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Legal Business Name | MIDSOUTH A GENTIVA COMPANY
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 631 BEACON PKWY W
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3124
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Country | US
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Telephone | 205-945-4859
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Fax | 205-945-8605
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Provider Business Mailing Address
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Address Line | 631 BEACON PKWY W
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3124
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Country | US
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Telephone | 205-945-4859
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Fax | 205-945-8605
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | BRENDA LONG CHAPPELL
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Credential |
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Telephone | 205-945-4859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PTH1397
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License Number State | AL
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