Provider Demographics
NPI:1255989307
Name:WIREGRASS MEDICAL HOLDINGS LLC
Entity type:Organization
Organization Name:WIREGRASS MEDICAL HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-446-5285
Mailing Address - Street 1:566 W CARROLL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4376
Mailing Address - Country:US
Mailing Address - Phone:334-446-5285
Mailing Address - Fax:
Practice Address - Street 1:566 W CARROLL ST STE 3
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4376
Practice Address - Country:US
Practice Address - Phone:334-446-5285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies