Organization
SOUTHERN MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. T. MICHAEL NELSON (PRESIDENT)
(205) 822-1972
Entity
Organization
Contact information
Practice address
2159 ROCKY RIDGE RD, SUITE 123, HOOVER, AL 35216
(205) 822-1972
(205) 822-2821
Mailing address
2159 ROCKY RIDGE RD, SUITE 123, HOOVER, AL 35216
(205) 822-1972
(205) 822-2821
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
110489
AL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
110489
AL
3336H0001X
Home Infusion Therapy Pharmacy
Primary
110489
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009703250
—
AL
01
—
0128199
NCPDP OR NABP NUMBER
AL
05
—
100002722
—
AL
01
—
51057969
BCBS DME PROVIDER
AL
01
—
51527724
BCBS HOME HEALTH PROVIDER
AL
Enumeration date
07/28/2006
Last updated
06/25/2008
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