Provider Demographics
NPI:1699043695
Name:GULFSOUTH MEDICAL LLC
Entity Type:Organization
Organization Name:GULFSOUTH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-379-5912
Mailing Address - Street 1:205 BELLEVUE CIR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2271
Mailing Address - Country:US
Mailing Address - Phone:251-379-5912
Mailing Address - Fax:251-343-6696
Practice Address - Street 1:205 BELLEVUE CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2271
Practice Address - Country:US
Practice Address - Phone:251-379-5912
Practice Address - Fax:251-343-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies