Provider Demographics
NPI:1043230816
Name:THE MEDICAL STORE INC
Entity Type:Organization
Organization Name:THE MEDICAL STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-769-6414
Mailing Address - Street 1:1201 COLLEGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2406
Mailing Address - Country:US
Mailing Address - Phone:251-246-0444
Mailing Address - Fax:251-246-7544
Practice Address - Street 1:1201 COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2406
Practice Address - Country:US
Practice Address - Phone:251-246-0444
Practice Address - Fax:251-246-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000056488Medicaid
AL51056488OtherBCBS PROV #
MS0040362Medicaid
AL000056488Medicaid