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General NPI Number Information
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NPI Number | 1992763486
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Entity Type | Organization
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Legal Business Name | BRADBERRY MEDICAL LLC.
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 839 AIRPORT DRIVE SUITE 102
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City | ALEXANDER CITY
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State | AL
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Zip | 35010
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Country | US
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Telephone | 256-215-8654
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Fax | 256-215-8655
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Provider Business Mailing Address
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Address Line | 7856 WESTSIDE PARK DR SUITE C
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City | MOBILE
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State | AL
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Zip | 36695-8541
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Country | US
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Telephone | 251-633-8090
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Fax | 251-633-6941
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JERRY CARL JR.
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Credential |
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Telephone | 251-633-8090
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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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