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General NPI Number Information
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NPI Number | 1063224467
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Entity Type | Organization
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Legal Business Name | MID-MS MEDICAL
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 3304 8TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4755
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Country | US
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Telephone | 844-225-7160
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Fax | 386-343-7195
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Provider Business Mailing Address
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Address Line | 3304 8TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4755
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Country | US
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Telephone | 844-225-7160
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Fax | 386-343-7195
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RODERICK DALE SR.
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Credential |
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Telephone | 844-225-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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