Provider Demographics
NPI:1548262850
Name:PROFESSIONAL HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-221-8258
Mailing Address - Street 1:14965 STATE HIGHWAY 59 STE 102
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2471
Mailing Address - Country:US
Mailing Address - Phone:251-928-4922
Mailing Address - Fax:251-928-4990
Practice Address - Street 1:14965 STATE HIGHWAY 59 STE 102
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2471
Practice Address - Country:US
Practice Address - Phone:251-928-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6714332BP3500X, 332B00000X
AL900048332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000056323Medicaid
AL51596001OtherBLUE CROSS BLUE SHIELD
AL56323OtherBLUE CROSS BLUE SHIELD
AL0152230001Medicare NSC