MEDICARE: MED-SOUTH, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)	900057	AL
3	332B00000X	Durable Medical Equipment & Medical Supplies	187	AL

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	:	1750363198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-SOUTH, INC.

Provider Business Mailing Address
First Line	:	406 MEDICAL CENTER DRIVE
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-3400
Country	:	US
Telephone Number	:	205-221-8200
Fax Number	:	205-221-8270

Provider Business Practice Location Address
First Line	:	1420 N. MCKENZIE ST.
Second Line	:
City	:	FOLEY
State	:	AL
Zip	:	36535-2234
Country	:	US
Telephone Number	:	251-943-9119
Fax Number	:	251-970-1218

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA J. WELLS
Credential	:	CPCO
Telephone Number	:	205-221-8258

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/12/2019

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Directions to “MED-SOUTH, INC. ” Practice Location

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