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General NPI Number Information
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NPI Number | 1245265420
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Entity Type | Organization
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Legal Business Name | METRO MEDICAL SUPPLY COMPANY LLC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 5268 OLD HIGHWAY 11 SUITE 2
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City | HATTIESBURG
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State | MS
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Zip | 39402-8379
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Country | US
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Telephone | 601-268-6939
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Fax | 601-268-6089
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Provider Business Mailing Address
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Address Line | PO BOX 16595
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City | HATTIESBURG
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State | MS
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Zip | 39404-6595
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Country | US
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Telephone | 601-268-6939
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Fax | 601-268-6089
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Authorized Official
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Title or Position | OWNER
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Name | WANDA HARDEN
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Credential |
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Telephone | 601-268-6939
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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 | 037-06632-1
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License Number State | MS
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