Healthcare Provider Details

I. General information

NPI: 1205932076
Provider Name (Legal Business Name): MEDSTOCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 EAST MAIN STREET
MARKS MS
38646
US

IV. Provider business mailing address

206 EAST MAIN STREET
MARKS MS
38646
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-4433
  • Fax: 662-326-2333
Mailing address:
  • Phone: 662-326-4433
  • Fax: 662-326-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE7233
License Number StateMS

VIII. Authorized Official

Name: MR. CLAYTON TAYLOR VANCE
Title or Position: PRESIDENT. CEO
Credential:
Phone: 662-326-4433