Provider Demographics
NPI:1023770476
Name:MODERN MEDICAL CONCEPTS HOMECARE, INC
Entity type:Organization
Organization Name:MODERN MEDICAL CONCEPTS HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KLEINKLAUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-442-5225
Mailing Address - Street 1:110 MMC PKWY
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5852
Mailing Address - Country:US
Mailing Address - Phone:256-442-5225
Mailing Address - Fax:256-442-5228
Practice Address - Street 1:128 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1722
Practice Address - Country:US
Practice Address - Phone:256-849-0226
Practice Address - Fax:256-849-0729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1942266499
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000033903Medicaid