Organization
SOUTHERN EXPRESS MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BRUCE (OWNER)
(334) 376-0003
Entity
Organization
Contact information
Practice address
125 CHURCH ST, SUITE B, GEORGIANA, AL 36033
(334) 376-0003
(334) 376-5777
Mailing address
PO BOX 710, GEORGIANA, AL 36033
(334) 376-0003
(334) 376-5777
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000077252
—
AL
01
—
305157
HEALTH INS CORP OF AL
AL
01
—
51077252
BCBS PROVIDER NUMBER
AL
Enumeration date
07/15/2005
Last updated
10/12/2015
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