MEDICARE: MED360 LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1831819820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED360 LLC

Provider Business Mailing Address
First Line	:	407 SUMRALL RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-9550
Country	:	US
Telephone Number	:	601-345-5424
Fax Number	:	601-519-0772

Provider Business Practice Location Address
First Line	:	407 SUMRALL RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-9550
Country	:	US
Telephone Number	:	601-345-5424
Fax Number	:	601-519-0772

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL DON SCHEPEMAKER
Credential	:	FNP, PMHNP
Telephone Number	:	601-345-5424

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	03/12/2026

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