Provider Demographics
NPI:1588953798
Name:CHAMPION MEDICAL SYSTEMS, LLC
Entity type:Organization
Organization Name:CHAMPION MEDICAL SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:NZERIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-588-6111
Mailing Address - Street 1:1220 16TH ST S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4716
Mailing Address - Country:US
Mailing Address - Phone:205-588-6111
Mailing Address - Fax:205-588-8113
Practice Address - Street 1:1220 16TH ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4716
Practice Address - Country:US
Practice Address - Phone:205-588-6111
Practice Address - Fax:205-588-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL201269332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL201269OtherCITY OF BIRMINGHAM BUSINESS LICENSE