Provider Demographics
NPI:1033292727
Name:VONPATTON'S, LLC
Entity Type:Organization
Organization Name:VONPATTON'S, LLC
Other - Org Name:NORWOOD MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-792-2224
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-0953
Mailing Address - Country:US
Mailing Address - Phone:601-792-2224
Mailing Address - Fax:601-792-2444
Practice Address - Street 1:2218 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474
Practice Address - Country:US
Practice Address - Phone:601-792-2224
Practice Address - Fax:601-792-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06730/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00706576Medicaid
MS00706576Medicaid