Provider Demographics
NPI:1770597262
Name:SOUTHERN MEDICAL, INC.
Entity type:Organization
Organization Name:SOUTHERN MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:T. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-822-1972
Mailing Address - Street 1:2159 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-822-1972
Mailing Address - Fax:205-822-2821
Practice Address - Street 1:2159 ROCKY RIDGE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-822-1972
Practice Address - Fax:205-822-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 251E00000X
AL110489333600000X, 251F00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51057969OtherBCBS DME PROVIDER
AL51527724OtherBCBS HOME HEALTH PROVIDER
AL009703250Medicaid
AL0128199OtherNCPDP OR NABP NUMBER
AL100002722Medicaid
AL0720330001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER