Healthcare Provider Details

I. General information

NPI: 1619203007
Provider Name (Legal Business Name): MED SUPPLY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S FULTON DR
CORINTH MS
38834-6017
US

IV. Provider business mailing address

1019 TOWN DR
HIGHLAND HEIGHTS KY
41076-9114
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-8222
  • Fax: 662-286-8333
Mailing address:
  • Phone: 859-441-8876
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: GREGORY J CRAWFORD
Title or Position: CEO
Credential:
Phone: 859-441-8876