Provider Demographics
NPI:1942298740
Name:280 MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:280 MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:ADS
Authorized Official - Phone:205-678-8755
Mailing Address - Street 1:11600 OLD HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-3000
Mailing Address - Country:US
Mailing Address - Phone:205-678-8755
Mailing Address - Fax:888-611-8229
Practice Address - Street 1:11600 OLD HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-3000
Practice Address - Country:US
Practice Address - Phone:205-678-8755
Practice Address - Fax:888-611-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AL652332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102569Medicaid
AL51512689OtherBCBS PROVIDER NUMBER
AL=========OtherTRICARE