Healthcare Provider Details

I. General information

NPI: 1952598153
Provider Name (Legal Business Name): CMA MEDICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N STATE ST SUITE A
JACKSON MS
39202-2627
US

IV. Provider business mailing address

901 N STATE ST SUITE A
JACKSON MS
39202-2627
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-7422
  • Fax: 601-355-5400
Mailing address:
  • Phone: 601-354-7422
  • Fax: 601-355-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number07517/11.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number07517/11.1
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA H FUNDERBURG
Title or Position: OWNER
Credential:
Phone: 601-354-7422