=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720432347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYER COMPANION CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2016
-----------------------------------------------------
Last Update Date | 04/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 OAK GROVE RD SUITE A
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-296-6300
-----------------------------------------------------
Fax | 601-296-6726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4626 JAMESTOWN AVE SUITE 6
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-638-3176
-----------------------------------------------------
Fax | 225-412-0057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | TERRI MYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-638-3176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------