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General NPI Number Information
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NPI Number | 1487666442
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Entity Type | Organization
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Legal Business Name | MEDI-SERV. INC.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 209 SOUTH HIGH STREET
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City | WAYNESBORO
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State | TN
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Zip | 38485-0871
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Country | US
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Telephone | 931-722-9047
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Fax | 931-722-9053
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Provider Business Mailing Address
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Address Line | POB 871
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City | WAYNESBORO
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State | TN
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Zip | 38485-0871
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Country | US
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Telephone | 931-722-9047
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Fax | 931-722-9053
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAIME T. MANGUBAT
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Credential | RRT
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Telephone | 931-722-9047
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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 | 0000001745
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License Number State | TN
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