Healthcare Provider Details

I. General information

NPI: 1740462563
Provider Name (Legal Business Name): BLOUNT MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 A PUBLIC SQUARE
CALHOUN CITY MS
38916
US

IV. Provider business mailing address

PO BOX 1425
CALHOUN CITY MS
38916-1425
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-1969
  • Fax: 800-628-1139
Mailing address:
  • Phone: 662-628-1969
  • Fax: 662-628-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS

VIII. Authorized Official

Name: TERESA BLOUNT
Title or Position: OWNER
Credential:
Phone: 662-628-1969