Provider Demographics
NPI:1568494219
Name:SPECIALISTS OF ENTERPRISE, INC
Entity type:Organization
Organization Name:SPECIALISTS OF ENTERPRISE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-393-2495
Mailing Address - Street 1:PO BOX 311621
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1621
Mailing Address - Country:US
Mailing Address - Phone:334-393-2495
Mailing Address - Fax:866-347-3894
Practice Address - Street 1:204 E BRUNSON ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1922
Practice Address - Country:US
Practice Address - Phone:334-393-2495
Practice Address - Fax:334-347-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL546332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009605670Medicaid
AL009605670Medicaid