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General NPI Number Information
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NPI Number | 1063967768
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Entity Type | Organization
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Legal Business Name | P-CARES MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 126 S COMMERCE ST STE 205
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City | NATCHEZ
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State | MS
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Zip | 39120-3317
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Country | US
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Telephone | 601-786-0888
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Fax | 844-580-5027
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Provider Business Mailing Address
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Address Line | 126 S COMMERCE ST STE 205
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City | NATCHEZ
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State | MS
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Zip | 39120-3317
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Country | US
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Telephone | 601-786-0888
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Fax | 844-580-5027
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Authorized Official
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Title or Position | OWNER
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Name | SVJATOSLAV JAKOVLEV
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Credential |
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Telephone | 601-786-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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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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