Provider Demographics
NPI:1073540654
Name:DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT
Other - Org Name:CENTER FOR DIABETES FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-9575
Mailing Address - Street 1:820 COOPER RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4099
Mailing Address - Country:US
Mailing Address - Phone:601-372-9575
Mailing Address - Fax:601-376-0404
Practice Address - Street 1:820 COOPER RD
Practice Address - Street 2:SUITE I
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4099
Practice Address - Country:US
Practice Address - Phone:601-372-9575
Practice Address - Fax:601-376-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015701Medicaid