MEDICARE: DURA-QUIP MEDICAL EQUIPMENT 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	332BX2000X	Oxygen Equipment & Supplies (DME)	02346/11.1	MS
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	02346/11.1	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	:	1548248800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURA-QUIP MEDICAL EQUIPMENT INC.

Provider Business Mailing Address
First Line	:	205 MAIN ST
Second Line	:	P O BOX 128
City	:	UNION
State	:	MS
Zip	:	39365-2521
Country	:	US
Telephone Number	:	601-774-8885
Fax Number	:	601-774-8810

Provider Business Practice Location Address
First Line	:	205 MAIN ST
Second Line	:
City	:	UNION
State	:	MS
Zip	:	39365-2521
Country	:	US
Telephone Number	:	601-774-8885
Fax Number	:	601-774-8810

Authorized Official
Title or Position	:	OWNER GENERAL MANAGER
Name	:	MS. SHIRLEY A FEDERICK
Credential	:
Telephone Number	:	601-774-8885

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/22/2012

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