Provider Demographics
NPI:1669727236
Name:MED SOUTH, INC.
Entity type:Organization
Organization Name:MED SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIFLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-221-8200
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:205-221-8282
Practice Address - Street 1:1120 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:256-766-7015
Practice Address - Fax:256-766-7016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
AL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition