Healthcare Provider Details

I. General information

NPI: 1134691314
Provider Name (Legal Business Name): P CARES MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 RIVER RD STE A
FAYETTE MS
39069-4602
US

IV. Provider business mailing address

3476 RIVER RD STE A
FAYETTE MS
39069-4602
US

V. Phone/Fax

Practice location:
  • Phone: 601-597-4840
  • Fax:
Mailing address:
  • Phone: 601-597-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ALFORD PERRYMAN
Title or Position: CEO / OWNER
Credential:
Phone: 601-786-0888