Healthcare Provider Details

I. General information

NPI: 1790959948
Provider Name (Legal Business Name): JAMES POE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E BAKER ST
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

124 E BAKER ST
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-4533
  • Fax: 662-887-4572
Mailing address:
  • Phone: 662-887-4533
  • Fax: 662-887-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01009
License Number StateMS

VIII. Authorized Official

Name: JIMMY R POE
Title or Position: OWNER
Credential: RPH
Phone: 662-887-4533