Provider Demographics
NPI:1013007236
Name:EAST ALABAMA DURABLE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:EAST ALABAMA DURABLE MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-756-7387
Mailing Address - Street 1:4500 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3541
Mailing Address - Country:US
Mailing Address - Phone:334-756-7387
Mailing Address - Fax:334-756-9106
Practice Address - Street 1:4500 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3541
Practice Address - Country:US
Practice Address - Phone:334-756-7387
Practice Address - Fax:334-756-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL196332B00000X, 332BP3500X
AL18633332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51054605OtherBCBS PROVIDER NUMBER
AL51054605OtherBCBS PROVIDER NUMBER