Provider Demographics
NPI:1083709778
Name:MED-PRO HOME HEALTH SUPPLY AND
Entity Type:Organization
Organization Name:MED-PRO HOME HEALTH SUPPLY AND
Other - Org Name:MEDICAL PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MCCAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-837-0950
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-2032
Mailing Address - Country:US
Mailing Address - Phone:662-837-0950
Mailing Address - Fax:662-837-0951
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2032
Practice Address - Country:US
Practice Address - Phone:662-837-0950
Practice Address - Fax:662-837-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS03816 / 11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherBLUE CROSS BLUE SHIELD OF
MS0144070001Medicare NSC