MEDICARE: SPECIALTY MEDICAL SUPPLY OF MISSISSIPPI, 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		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	:	1558343889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY MEDICAL SUPPLY OF MISSISSIPPI, INC.

Provider Business Mailing Address
First Line	:	103A E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2777
Country	:	US
Telephone Number	:	601-892-0360
Fax Number	:	601-892-6055

Provider Business Practice Location Address
First Line	:	103A E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2777
Country	:	US
Telephone Number	:	601-892-0360
Fax Number	:	601-892-6055

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WALTON AVERY BIGGS JR.
Credential	:
Telephone Number	:	601-892-0360

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/22/2020

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