Healthcare Provider Details

I. General information

NPI: 1922023860
Provider Name (Legal Business Name): MID-DELTA DURABLE MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W JACKSON ST
BELZONI MS
39038-3539
US

IV. Provider business mailing address

PO BOX 373
BELZONI MS
39038-0373
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-3660
  • Fax: 662-247-3884
Mailing address:
  • Phone: 662-247-1254
  • Fax: 662-247-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04739/11.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number04739/11.1
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number04739/11.1
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number04739/11.1
License Number StateMS

VIII. Authorized Official

Name: MRS. CLARA T. REED
Title or Position: CEO
Credential: RN
Phone: 662-247-1254