Healthcare Provider Details

I. General information

NPI: 1649379462
Provider Name (Legal Business Name): MEDICAL EQUIPMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 SWINNEA RDG SUITE 1
SOUTHAVEN MS
38671-6037
US

IV. Provider business mailing address

970 SWINNEA RDG SUITE 1
SOUTHAVEN MS
38671-6037
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-1663
  • Fax: 662-536-1677
Mailing address:
  • Phone: 662-536-1663
  • Fax: 662-536-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RAMONA MATTHEWS
Title or Position: CEO
Credential:
Phone: 662-536-1663