MEDICARE: VIKING MEDICAL SUPPLY INC

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	335E00000X	Prosthetic/Orthotic Supplier	128	AL
2	332B00000X	Durable Medical Equipment & Medical Supplies	312	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51093833VIK	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1629183314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIKING MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	PO BOX 550309
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-0309
Country	:	US
Telephone Number	:	205-631-8915
Fax Number	:	205-278-6900

Provider Business Practice Location Address
First Line	:	1201 3RD AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	205-631-8915
Fax Number	:	205-278-6900

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. LONNIE BLAKE DORCEY
Credential	:	COF, RPT
Telephone Number	:	205-631-8915

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/02/2020

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