Provider Demographics
NPI:1407967938
Name:FOUR SEASONS MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:FOUR SEASONS MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-428-0147
Mailing Address - Street 1:4201 BESSEMER SUPER HWY
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-2412
Mailing Address - Country:US
Mailing Address - Phone:205-428-0147
Mailing Address - Fax:205-425-7231
Practice Address - Street 1:4201 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-2412
Practice Address - Country:US
Practice Address - Phone:205-428-0147
Practice Address - Fax:205-425-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06015325332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933183Medicaid
AL009933183Medicaid