Organization
SOUTHERN HOME RESPIRATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNEY DURIEL AUSTIN CRRT (CO-OWNER/PRESIDENT (CORP))
(334) 699-2630
Entity
Organization
Contact information
Practice address
1386 ROSS CLARK CIR, DOTHAN, AL 36301-4117
(334) 699-2630
(334) 699-2639
Mailing address
1386 ROSS CLARK CIR, DOTHAN, AL 36301-4117
(334) 699-2630
(334) 699-2630
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
117
AL
332BX2000X
Oxygen Equipment & Supplies (DME)
90265
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51095523
BCBS
AL
Enumeration date
09/27/2005
Last updated
10/25/2007
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