Healthcare Provider Details

I. General information

NPI: 1821740051
Provider Name (Legal Business Name): MISSISSIPPI MED SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301B HIGHWAY 72 E
CORINTH MS
38834-6023
US

IV. Provider business mailing address

PO BOX 1139
CORINTH MS
38835-1139
US

V. Phone/Fax

Practice location:
  • Phone: 662-808-0856
  • Fax:
Mailing address:
  • Phone: 662-808-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: GARY KEITH BARNETT
Title or Position: PRESIDENT
Credential:
Phone: 662-808-0856