Organization
BLACK BELT MEDICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY CARL JR. (CEO/PRESIDENT)
(251) 633-8090
Entity
Organization
Contact information
Practice address
1004 JEFF DAVIS AVE, SELMA, AL 36701-4519
(334) 872-9721
(334) 874-4923
Mailing address
7856 WESTSIDE PARK DR, SUITE C, MOBILE, AL 36695-8541
(251) 633-8090
(251) 633-6941
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51516028
BLUE CROSS BLUE SHIELD
AL
Enumeration date
05/03/2006
Last updated
03/27/2008
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