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General NPI Number Information
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NPI Number | 1154030369
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Entity Type | Organization
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Legal Business Name | KEYSTONE MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 106 HIGHLAND WAY STE 204
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City | MADISON
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State | MS
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Zip | 39110-6933
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Country | US
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Telephone | 833-847-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 106 HIGHLAND WAY STE 204
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City | MADISON
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State | MS
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Zip | 39110-6933
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Country | US
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Telephone | 833-847-1240
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JEFF KING
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Credential |
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Telephone | 601-707-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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