MEDICARE: DURABLE MEDICAL EQUIPMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073540654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURABLE MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	820 COOPER RD
Second Line	:	SUITE I
City	:	JACKSON
State	:	MS
Zip	:	39212-4099
Country	:	US
Telephone Number	:	601-372-9575
Fax Number	:	601-376-0404

Provider Business Practice Location Address
First Line	:	820 COOPER RD
Second Line	:	SUITE I
City	:	JACKSON
State	:	MS
Zip	:	39212-4099
Country	:	US
Telephone Number	:	601-372-9575
Fax Number	:	601-376-0404

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. KATHLEEN EVANS REED
Credential	:
Telephone Number	:	601-372-9575

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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Directions to “DURABLE MEDICAL EQUIPMENT ” Practice Location

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