Healthcare Provider Details

I. General information

NPI: 1447881966
Provider Name (Legal Business Name): PATTON DURABLE EQUIPMENT SUPPLIES,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CLINTON BLVD
CLINTON MS
39056-5217
US

IV. Provider business mailing address

305 CLINTON BLVD
CLINTON MS
39056-5217
US

V. Phone/Fax

Practice location:
  • Phone: 601-708-5097
  • Fax: 601-708-5096
Mailing address:
  • Phone: 601-708-5097
  • Fax: 601-708-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROY C PATTON SR.
Title or Position: OWNER
Credential:
Phone: 601-708-5097