Provider Demographics
NPI:1770569428
Name:MED-SOUTH, INC.
Entity type:Organization
Organization Name:MED-SOUTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT CORPORATE COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPCO
Authorized Official - Phone:205-221-8258
Mailing Address - Street 1:406 MEDICAL CENTER DRIVE
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 1:1706 GLENN BLVD. SW
Practice Address - Street 2:
Practice Address - City:FT. PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3543
Practice Address - Country:US
Practice Address - Phone:256-845-3309
Practice Address - Fax:256-845-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
AL900164332BX2000X
AL137332B00000X
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
AL000052881Medicaid
AL0336010024Medicare NSC