=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861685414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL SUPPLIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 08/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 S DALTON ST
-----------------------------------------------------
City | SLOCOMB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36375-5483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-886-9111
-----------------------------------------------------
Fax | 334-886-9255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 S DALTON ST P.O. BOX 580
-----------------------------------------------------
City | SLOCOMB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36375-5483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-886-9111
-----------------------------------------------------
Fax | 334-886-9255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES ANTHONY EUBANKS SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-886-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 129
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 129
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------