Organization
PROVIDENCE HOME MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA J. WELLS CPCO (EXECUTIVE DIRECTOR)
(205) 221-8258
Entity
Organization
Contact information
Practice address
6701 AIRPORT BLVD., STE. B-121, MOBILE, AL 36608-6705
(251) 633-7491
(251) 633-7492
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
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163809
—
AL
Enumeration date
09/19/2013
Last updated
11/12/2019
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