Provider Demographics
NPI:1861478133
Name:MED-SOUTH, INC.
Entity Type:Organization
Organization Name:MED-SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT OF CORPORATE DEVL
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:H
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-414-7525
Mailing Address - Street 1:406 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3400
Mailing Address - Country:US
Mailing Address - Phone:205-221-8200
Mailing Address - Fax:205-221-8270
Practice Address - Street 1:1029 W FORT WILLIAMS ST
Practice Address - Street 2:SUITE A
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2301
Practice Address - Country:US
Practice Address - Phone:256-245-3007
Practice Address - Fax:256-245-3068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL181332B00000X
332BP3500X
AL900125332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009610960Medicaid
AL0336010021Medicare NSC