Healthcare Provider Details

I. General information

NPI: 1982928768
Provider Name (Legal Business Name): KILMICHAEL MEDICAL SUPPLIERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR STE J
GRENADA MS
38901-4083
US

IV. Provider business mailing address

1300 SUNSET DR STE J
GRENADA MS
38901-4083
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-2885
  • Fax: 662-227-2887
Mailing address:
  • Phone: 662-227-2885
  • Fax: 662-227-2887

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: MISS JENNIFER G CAMPBELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-283-1551