Healthcare Provider Details

I. General information

NPI: 1285631614
Provider Name (Legal Business Name): AT HOME MEDICAL SUPPLY OF HOLLY SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 HIGHWAY 7 S BOX C
HOLLY SPRINGS MS
38635-9108
US

IV. Provider business mailing address

621 HIGHWAY 7 S BOX C
HOLLY SPRINGS MS
38635-9108
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-9148
  • Fax: 662-252-2320
Mailing address:
  • Phone: 800-748-9148
  • Fax: 662-252-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number03810/11.1
License Number StateMS

VIII. Authorized Official

Name: MRS. SUE OAKLEY
Title or Position: STORE MANAGER
Credential:
Phone: 800-748-9148