MEDICARE: MISSISSIPPI MEDICAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	025331018	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235134065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI MEDICAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 13892
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39236-3892
Country	:	US
Telephone Number	:	601-952-0124
Fax Number	:	601-978-1736

Provider Business Practice Location Address
First Line	:	5836 N COMMERCE PLZ
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-2936
Country	:	US
Telephone Number	:	601-952-0124
Fax Number	:	601-978-1736

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS FARRIS JAMISON
Credential	:
Telephone Number	:	601-952-0124

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	09/16/2009

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Directions to “MISSISSIPPI MEDICAL, INC ” Practice Location

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