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General NPI Number Information
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NPI Number | 1164877379
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Entity Type | Organization
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Legal Business Name | AT HOME MEDICAL SUPPLY
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 306 CHURCH ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2108
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Country | US
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Telephone | 601-437-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 5015 I 55 N STE B
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City | JACKSON
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State | MS
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Zip | 39206-4306
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Country | US
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Telephone | 601-362-3019
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Fax | 601-362-0405
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Authorized Official
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Title or Position | CEO
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Name | JEANETTE FELTON
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Credential |
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Telephone | 601-437-3524
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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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