| Name: | Med South Home Medical Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 May 2017 (7 years ago) (Companies founded in May 2017) |
| Entity Number: | 000-392-635 |
| Register Number: | 000392635 |
| Historical Names: |
SAMC Home Medical Equipment, LLC
|
| ZIP code: | 35501 (Companies in Walker, 35501) |
| County: | Walker |
| Place of Formation: | Walker County |
| Registered Office Street Address: | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316468515 | 2017-06-28 | 2019-11-12 | 406 MEDICAL CENTER DR., JASPER, AL, 355013400, US | 205 E. LEE STREET, ENTERPRISE, AL, 363302626, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-221-8200 |
| Fax | 2052218270 |
| Phone | +1 334-308-1355 |
| Fax | 3343081358 |
Authorized person
| Name | MS. LISA J. WELLS |
| Role | EXECUTIVE DIRECTOR |
| Phone | 2052218258 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 219493 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WILLINGHAM, PATRICK | Agent | 510 MEDICAL ARTS TOWERJASPER, AL 35501 |
| Name | Role | Address |
|---|---|---|
| MED-SOUTH INC | Member | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
| Name | Role | Address |
|---|---|---|
| MED-SOUTH INC | Organizer | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2019-02-06 | Name Change | SAMC Home Medical Equipment, LLC | Med South Home Medical Services, LLC |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
