| NPI | 1801159157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMEKIA JACKSON Administrator 662-563-1641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: MS F11388) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |