Provider Demographics
NPI:1245214006
Name:EAST ALABAMA HOMEMED LLC
Entity type:Organization
Organization Name:EAST ALABAMA HOMEMED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:STOUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-500-1977
Mailing Address - Street 1:PO BOX 4043
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-4043
Mailing Address - Country:US
Mailing Address - Phone:334-741-7410
Mailing Address - Fax:334-742-0032
Practice Address - Street 1:1908 PEPPERELL PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5473
Practice Address - Country:US
Practice Address - Phone:334-741-7410
Practice Address - Fax:334-742-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL557332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6211420001Medicare NSC