Organization
MIDSTATE MEDICAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD CHERRY (PRESIDENT)
(334) 263-6034
Entity
Organization
Contact information
Practice address
1507 MULBERRY ST, MONTGOMERY, AL 36106-1519
(334) 263-6034
(334) 264-2436
Mailing address
PO BOX 6070, MONTGOMERY, AL 36106-0070
(334) 263-6034
(334) 264-2436
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0003497
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000051822
—
AL
01
—
0007965237
AETNA PROVIDER NUMBER
AL
01
—
304307
COMBINED INS. CO. OF AMER
AL
05
—
4582366
—
TN
01
—
51051822MID
BCBS PROVIDER NUMBER
AL
01
—
U98718
AMERIHEALTH PROV. NUM.
AL
01
—
V16192
VGM/HOMELINK PROV. NUM.
AL
Enumeration date
06/21/2006
Last updated
06/20/2018
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