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General NPI Number Information
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NPI Number | 1407889934
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Entity Type | Organization
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Legal Business Name | LONGWIND PRODUCT & SERVICE, INC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 205 W WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39213-7647
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Country | US
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Telephone | 601-366-2215
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Fax | 601-366-9813
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Provider Business Mailing Address
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Address Line | PO BOX 11838
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City | JACKSON
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State | MS
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Zip | 39283-1838
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Country | US
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Telephone | 601-366-2215
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Fax | 601-366-9813
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Authorized Official
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Title or Position | CEO
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Name | MR. LONNIE WALKER
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Credential |
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Telephone | 601-366-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 06693/11.1
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License Number State | MS
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