MEDICARE: MEDSOUTHHEALTHCENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1184034613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSOUTHHEALTHCENTER, LLC

Provider Business Mailing Address
First Line	:	2200 MADISON AVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-1914
Country	:	US
Telephone Number	:	334-578-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 MADISON AVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-1914
Country	:	US
Telephone Number	:	334-578-2200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/MANAGER
Name	:	DARREL PACE
Credential	:
Telephone Number	:	334-578-2200

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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