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General NPI Number Information
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NPI Number | 1497928626
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Entity Type | Organization
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Legal Business Name | MED-MART HOME CARE INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 211 N MAIN ST
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City | WATER VALLEY
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State | MS
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Zip | 38965-2504
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Country | US
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Telephone | 662-473-4426
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Fax | 662-473-4427
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Provider Business Mailing Address
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Address Line | 211 N MAIN ST
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City | WATER VALLEY
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State | MS
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Zip | 38965-2504
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Country | US
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Telephone | 662-473-4426
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Fax | 662-473-4427
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. THOMAS ASHLEY BUTLER
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Credential |
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Telephone | 662-489-9330
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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 | 1132590001
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1132590001
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License Number State | MS
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