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Organization
PROVIDENCE HOME MEDICAL SERVICES, LLC
Active
Organization
PROVIDENCE HOME MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA J. WELLS CPCO (EXECUTIVE DIRECTOR)
(205) 221-8258
Entity
Organization
Contact information
Practice address
6701 AIRPORT BLVD., STE. B-121, MOBILE, AL 36608-6705
(251) 633-7491
(251) 633-7492
Mailing address
406 MEDICAL CENTER DR., JASPER, AL 35501-3400
(205) 221-8200
(205) 221-8270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163809
—
AL
Enumeration date
09/19/2013
Last updated
11/12/2019
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