Healthcare Provider Details

I. General information

NPI: 1184685653
Provider Name (Legal Business Name): MIDSOUTH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 BREARD ST
MONROE LA
71201-3911
US

IV. Provider business mailing address

PO BOX 4927
MONROE LA
71211-4927
US

V. Phone/Fax

Practice location:
  • Phone: 318-855-0411
  • Fax: 855-420-5858
Mailing address:
  • Phone: 318-855-0411
  • Fax: 855-420-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number35109770D
License Number StateLA

VIII. Authorized Official

Name: MS. REBECCA JONES
Title or Position: OWNER
Credential:
Phone: 318-855-0411