Healthcare Provider Details

I. General information

NPI: 1629009063
Provider Name (Legal Business Name): AVRITT MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DESOTO AVE
CLARKSDALE MS
38614-6930
US

IV. Provider business mailing address

4020 HIGHWAY 8
CLEVELAND MS
38732-8551
US

V. Phone/Fax

Practice location:
  • Phone: 662-627-7702
  • Fax: 662-627-7889
Mailing address:
  • Phone: 662-843-7007
  • Fax: 662-843-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0390111.1
License Number StateMS

VIII. Authorized Official

Name: CHARLES R AVRITT
Title or Position: PRESIDENT
Credential:
Phone: 662-843-7007