Provider Demographics
NPI:1104863034
Name:MS MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:MS MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-894-0411
Mailing Address - Street 1:121 W GALLATIN ST
Mailing Address - Street 2:P.O. BOX 786
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-3024
Mailing Address - Country:US
Mailing Address - Phone:601-894-0411
Mailing Address - Fax:601-894-0455
Practice Address - Street 1:121 W GALLATIN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3024
Practice Address - Country:US
Practice Address - Phone:601-894-0411
Practice Address - Fax:601-894-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06161332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05371344Medicaid
MS4955360001Medicare ID - Type Unspecified