Provider Demographics
NPI:1083807218
Name:AMBER L. CLANTON LLC DBA HEALTHWISE
Entity Type:Organization
Organization Name:AMBER L. CLANTON LLC DBA HEALTHWISE
Other - Org Name:HEALTHWISE MEDICAL EQUIPTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-899-5462
Mailing Address - Street 1:6955 OLD CANTON RD STE L
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1267
Mailing Address - Country:US
Mailing Address - Phone:601-899-5642
Mailing Address - Fax:601-899-5643
Practice Address - Street 1:6955 OLD CANTON RD STE L
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1267
Practice Address - Country:US
Practice Address - Phone:601-899-5642
Practice Address - Fax:601-899-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6003830001Medicare NSC