Provider Demographics
NPI:1588683270
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 1:104 OXMOOR RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5936
Mailing Address - Country:US
Mailing Address - Phone:662-680-4343
Mailing Address - Fax:662-680-4345
Practice Address - Street 1:1523 CLIFF GOOKIN BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6401
Practice Address - Country:US
Practice Address - Phone:662-680-4343
Practice Address - Fax:662-680-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05923/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0782330002Medicare NSC