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General NPI Number Information
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NPI Number | 1992890578
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Entity Type | Organization
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Legal Business Name | CROSSROADS MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 ALCORN DRIVE
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-286-8222
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Fax | 662-286-8333
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Provider Business Mailing Address
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Address Line | 203 ALCORN DRIVE
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-286-8222
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Fax | 662-286-8333
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN S. DALTON
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Credential |
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Telephone | 662-286-8222
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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 | 06937/11.1
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License Number State | MS
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