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General NPI Number Information
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NPI Number | 1902963994
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Entity Type | Organization
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Legal Business Name | MID SOUTH MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 501 FALLS BLVD S
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City | WYNNE
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State | AR
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Zip | 72396-3513
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Country | US
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Telephone | 870-238-4242
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Fax | 870-238-4035
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Provider Business Mailing Address
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Address Line | PO BOX 1067
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City | WYNNE
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State | AR
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Zip | 72396-1067
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Country | US
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Telephone | 870-238-4242
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Fax | 870-238-4035
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT D BETHELL JR.
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Credential |
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Telephone | 870-238-4242
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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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