Provider Demographics
NPI:1033126123
Name:AZALEA CITY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:AZALEA CITY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-287-7067
Mailing Address - Street 1:3046 DAUPHIN ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-3835
Mailing Address - Country:US
Mailing Address - Phone:251-287-7067
Mailing Address - Fax:251-461-6439
Practice Address - Street 1:3046 DAUPHIN ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3835
Practice Address - Country:US
Practice Address - Phone:251-287-7067
Practice Address - Fax:251-461-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111612332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910827Medicaid
AL51506953OtherBLUECROSSBLUESHIELD
AL009910827Medicaid