MEDICARE: SOUTHERNCARE 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	251G00000X	Community Based Hospice Care Agency	0141HSP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720027519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERNCARE INC

Provider Business Mailing Address
First Line	:	2204 LAKESHORE DR
Second Line	:	SUITE 475
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6705
Country	:	US
Telephone Number	:	205-868-4400
Fax Number	:	205-868-4401

Provider Business Practice Location Address
First Line	:	3077 KETTERING BLVD
Second Line	:	STE 100
City	:	MORAINE
State	:	OH
Zip	:	45439-1949
Country	:	US
Telephone Number	:	937-293-3603
Fax Number	:	937-293-3646

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. MICHAEL J PARSONS
Credential	:
Telephone Number	:	205-868-4400

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/27/2009

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Directions to “SOUTHERNCARE INC ” Practice Location

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