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)	080255	AL
3	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1871770156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-SOUTH, INC.

Provider Business Mailing Address
First Line	:	406 MEDICAL CENTER DR.
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	:	4505 HWY. 78 E.
Second Line	:	STE. 100
City	:	JASPER
State	:	AL
Zip	:	35501-3400
Country	:	US
Telephone Number	:	205-384-3626
Fax Number	:	205-384-5526

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

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	11/13/2019

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

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