Healthcare Provider Details

I. General information

NPI: 1457468167
Provider Name (Legal Business Name): MCKENZIE HEALTHCARE SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRISON STREET
FAYETTE MS
39069
US

IV. Provider business mailing address

5 HARRISON STREET
FAYETTE MS
39069
US

V. Phone/Fax

Practice location:
  • Phone: 601-786-3700
  • Fax: 601-786-0037
Mailing address:
  • Phone: 601-786-3700
  • Fax: 601-786-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. SHEDRICK MCKENZIE
Title or Position: OWNER
Credential:
Phone: 601-786-3700