Organization
DURA MED SOUTHEAST, INC.
Active
Other names
Southland Vital Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK R. FLOYD (PRESIDENT)
(251) 578-1333
Entity
Organization
Contact information
Practice address
100 E FRONT ST, EVERGREEN, AL 36401-2927
(251) 578-1333
(251) 578-1333
Mailing address
PO BOX 190, EVERGREEN, AL 36401-0190
(251) 578-1333
(251) 578-1333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
111970
AL
332BC3200X
Customized Equipment (DME)
111970
AL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
111970
AL
332BX2000X
Oxygen Equipment & Supplies (DME)
111970
AL
333600000X
Pharmacy
111970
AL
3336C0003X
Community/Retail Pharmacy
111970
AL
3336H0001X
Home Infusion Therapy Pharmacy
111970
AL
3336L0003X
Long Term Care Pharmacy
111970
AL
3336M0002X
Mail Order Pharmacy
111970
AL
3336S0011X
Specialty Pharmacy
Primary
111970
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16252100
OWCP
—
01
—
515-05269
BCBS
AL
Enumeration date
06/22/2006
Last updated
09/11/2025
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