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General NPI Number Information
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NPI Number | 1548455884
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Entity Type | Organization
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Legal Business Name | CHARTER MEDICAL, LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 510 AZALEA DRIVE SUITE 100
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-533-9000
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Fax | 866-838-7780
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Provider Business Mailing Address
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Address Line | 510 AZALEA DRIVE SUITE 100
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-533-9000
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Fax | 866-838-7780
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH K GOWEN III
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Credential |
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Telephone | 662-533-9000
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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 | 07500/11.1
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License Number State | MS
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