Provider Demographics
NPI:1134146830
Name:SOUTHERN PATIENT CARE, INC.
Entity Type:Organization
Organization Name:SOUTHERN PATIENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-776-8323
Mailing Address - Street 1:120 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-4469
Mailing Address - Country:US
Mailing Address - Phone:205-776-8323
Mailing Address - Fax:205-776-8329
Practice Address - Street 1:104 OXMOOR RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5936
Practice Address - Country:US
Practice Address - Phone:205-776-8323
Practice Address - Fax:205-776-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23347332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050434Medicaid
AL0782330001Medicare NSC