Provider Demographics
NPI:1497291173
Name:CHAMPION MEDICAL SERVICES
Entity Type:Organization
Organization Name:CHAMPION MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:NZERIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-224-9494
Mailing Address - Street 1:2550 FIVE STAR PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-3313
Mailing Address - Country:US
Mailing Address - Phone:205-224-9494
Mailing Address - Fax:
Practice Address - Street 1:2550 FIVE STAR PKWY STE 112
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-3313
Practice Address - Country:US
Practice Address - Phone:205-224-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2550FS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2550FSOtherHBASIS