=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174459010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME MED SERVES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2026
-----------------------------------------------------
Last Update Date | 06/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 ROY BURGE RD
-----------------------------------------------------
City | POPLARVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39470-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-663-0287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 ROY BURGE RD
-----------------------------------------------------
City | POPLARVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39470-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAJER
-----------------------------------------------------
Name | BILLY SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-663-0287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------