Provider Demographics
NPI:1871569129
Name:DEEP SOUTH HOME MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:DEEP SOUTH HOME MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FLOURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-671-9484
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:229 SUNRISE LANE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AL
Practice Address - Zip Code:36349
Practice Address - Country:US
Practice Address - Phone:334-671-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL065560332B00000X
AL112249333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009918095Medicaid
AL009918095Medicaid
AL4750170001Medicare ID - Type Unspecified