Provider Demographics
NPI:1922103852
Name:SPECIALIZED MEDICAL DEVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED MEDICAL DEVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-536-7676
Mailing Address - Street 1:2905 WESTCORP BLVD SW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-6411
Mailing Address - Country:US
Mailing Address - Phone:256-536-7676
Mailing Address - Fax:256-536-7638
Practice Address - Street 1:1104 BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1438
Practice Address - Country:US
Practice Address - Phone:256-760-0050
Practice Address - Fax:256-536-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0274100007Medicare NSC