Provider Demographics
NPI:1023319837
Name:PERRY D VICKERS
Entity type:Organization
Organization Name:PERRY D VICKERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-924-9999
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-0600
Mailing Address - Country:US
Mailing Address - Phone:205-924-9999
Mailing Address - Fax:205-924-1998
Practice Address - Street 1:31040 NE 1ST AVE
Practice Address - Street 2:STE 5
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549-4152
Practice Address - Country:US
Practice Address - Phone:205-924-9999
Practice Address - Fax:205-924-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5641650001Medicare NSC