Organization
COOSA VALLEY RESPIRATORY & HOME MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA J. WELLS JR. CPCO (EXECUTIVE DIRECTOR)
(205) 221-8258
Entity
Organization
Contact information
Practice address
201 W. FT. WILLIAMS ST., STE. 28, SYLACAUGA, AL 35150-2468
(256) 245-1411
(256) 245-1471
Mailing address
406 MEDICAL CENTER DR., JASPER, AL 35501-3400
(205) 221-8200
(205) 221-8270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
634
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932266
—
AL
Enumeration date
05/09/2006
Last updated
11/12/2019
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