Provider Demographics
NPI:1851308845
Name:HEALTHMARK HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:HEALTHMARK HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:SURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-418-0085
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0853
Mailing Address - Country:US
Mailing Address - Phone:334-418-0085
Mailing Address - Fax:334-418-4719
Practice Address - Street 1:2918 CITIZENS PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-418-0085
Practice Address - Fax:334-418-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009710160Medicaid
AL1171630001Medicare NSC