Healthcare Provider Details

I. General information

NPI: 1790985406
Provider Name (Legal Business Name): MS MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 DELAWARE AVE
MCCOMB MS
39648-3636
US

IV. Provider business mailing address

407C APACHE DR
MCCOMB MS
39648-6311
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-8070
  • Fax: 601-684-0513
Mailing address:
  • Phone: 601-684-0511
  • Fax: 601-684-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number02002/11.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02002/11.1
License Number StateMS

VIII. Authorized Official

Name: LEE ROMERO
Title or Position: PRESIDENT
Credential:
Phone: 601-384-6276