Provider Demographics
NPI:1033376611
Name:MR B'S
Entity Type:Organization
Organization Name:MR B'S
Other - Org Name:BMOBILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AISSITVE TECHNOLOGIST-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-7171
Mailing Address - Street 1:1309 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2913
Mailing Address - Country:US
Mailing Address - Phone:228-875-7171
Mailing Address - Fax:228-875-1162
Practice Address - Street 1:1309 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2913
Practice Address - Country:US
Practice Address - Phone:228-875-7171
Practice Address - Fax:228-875-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS030-18892-4332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment