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General NPI Number Information
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NPI Number | 1861510562
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Entity Type | Organization
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Legal Business Name | MID-SOUTH MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 17860 HIGHWAY 432
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City | CLINTON
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State | LA
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Zip | 70722-4026
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Country | US
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Telephone | 225-683-6111
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Fax | 225-683-6885
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Provider Business Mailing Address
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Address Line | 17860 HIGHWAY 432
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City | CLINTON
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State | LA
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Zip | 70722-4026
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Country | US
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Telephone | 225-683-6111
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Fax | 225-683-6885
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SHANNON DEVALL
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Credential |
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Telephone | 225-683-6111
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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 |
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License Number State |
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