Healthcare Provider Details

I. General information

NPI: 1265418958
Provider Name (Legal Business Name): MSI HOME MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 HWY 39 N STE A
MERIDIAN MS
39301-2609
US

IV. Provider business mailing address

406 MEDICAL CENTER DR
JASPER AL
35501-3400
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-2005
  • Fax: 601-693-0060
Mailing address:
  • Phone: 205-221-8200
  • Fax: 205-221-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04420/11.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number04420/11.1
License Number StateMS

VIII. Authorized Official

Name: MR. STEWART H PACE
Title or Position: PRESIDENT, BOARD OF MANAGERS
Credential:
Phone: 205-655-6566