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General NPI Number Information
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NPI Number | 1730307802
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Entity Type | Organization
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Legal Business Name | GRACELAND MANAGEMENT COMPANY INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 ADAMS AVE
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City | OXFORD
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State | MS
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Zip | 38655-3213
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Country | US
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Telephone | 662-236-3200
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Fax | 662-513-0000
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Provider Business Mailing Address
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Address Line | 1212 ADAMS AVE
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City | OXFORD
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State | MS
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Zip | 38655-3213
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Country | US
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Telephone | 662-236-3200
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Fax | 662-513-0000
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MR. WILLIAM LARRY OVERSTREET
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Credential |
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Telephone | 662-236-3200
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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 | 0469511
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License Number State | MS
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