Healthcare Provider Details

I. General information

NPI: 1063967768
Provider Name (Legal Business Name): P-CARES MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S COMMERCE ST STE 205
NATCHEZ MS
39120-3317
US

IV. Provider business mailing address

126 S COMMERCE ST STE 205
NATCHEZ MS
39120-3317
US

V. Phone/Fax

Practice location:
  • Phone: 601-786-0888
  • Fax: 844-580-5027
Mailing address:
  • Phone: 601-786-0888
  • Fax: 844-580-5027

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 Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SVJATOSLAV JAKOVLEV
Title or Position: OWNER
Credential:
Phone: 601-786-0888