| NPI | 1952598153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA H FUNDERBURG Owner 601-354-7422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: MS 07517/11.1) |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: MS 07517/11.1) | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2009-01-14 |