Healthcare Provider Details

I. General information

NPI: 1063224467
Provider Name (Legal Business Name): MID-MS MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 8TH ST
MERIDIAN MS
39301-4755
US

IV. Provider business mailing address

3304 8TH ST
MERIDIAN MS
39301-4755
US

V. Phone/Fax

Practice location:
  • Phone: 844-225-7160
  • Fax: 386-343-7195
Mailing address:
  • Phone: 844-225-7160
  • Fax: 386-343-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RODERICK DALE SR.
Title or Position: DIRECTOR
Credential:
Phone: 844-225-7160