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General NPI Number Information
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NPI Number | 1184933384
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Entity Type | Organization
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Legal Business Name | JOHN D. WHITEHEAD
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 22743 HWY 12
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City | LEXINGTON
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State | MS
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Zip | 39095
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Country | US
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Telephone | 662-834-4600
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Fax | 662-834-4606
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Provider Business Mailing Address
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Address Line | PO BOX 652
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City | DURANT
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State | MS
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Zip | 39063
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Country | US
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Telephone | 662-834-4600
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Fax | 662-834-4606
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JOHN D. WHITEHEAD
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Credential | C.R.T
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Telephone | 662-834-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | RCP0972
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License Number State | MS
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