Healthcare Provider Details

I. General information

NPI: 1821094285
Provider Name (Legal Business Name): AVRITT MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E BAKER ST
INDIANOLA MS
38751-2404
US

IV. Provider business mailing address

4020 HIGHWAY 8
CLEVELAND MS
38732-8551
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-4055
  • Fax: 662-884-0888
Mailing address:
  • Phone: 662-843-7007
  • Fax: 662-843-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number06166/11.1
License Number StateMS

VIII. Authorized Official

Name: MRS. LILLIAN DELL HYDE
Title or Position: VP
Credential:
Phone: 662-843-7007