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General NPI Number Information
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NPI Number | 1518146455
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Entity Type | Organization
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Legal Business Name | INDIANOLA MEDICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 10/28/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 612 SUNFLOWER AVENUE EXT BUILDING 1-A
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City | INDIANOLA
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State | MS
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Zip | 38751-2333
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Country | US
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Telephone | 662-796-0705
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Fax | 662-796-1270
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Provider Business Mailing Address
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Address Line | 612 SUNFLOWER AVENUE EXT BUILDING 1-A
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City | INDIANOLA
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State | MS
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Zip | 38751-2333
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Country | US
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Telephone | 662-796-0705
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Fax | 662-796-1270
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TONYA THOMPSON
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Credential |
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Telephone | 662-207-8598
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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