Provider Demographics
NPI:1225121007
Name:MID-SOUTH MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:MID-SOUTH MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-837-4824
Mailing Address - Street 1:1021 CITY AVE N
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-1414
Mailing Address - Country:US
Mailing Address - Phone:662-837-4824
Mailing Address - Fax:662-837-0035
Practice Address - Street 1:1021 CITY AVE N
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1414
Practice Address - Country:US
Practice Address - Phone:662-837-4824
Practice Address - Fax:662-837-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
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
MS00440205Medicaid
MS00440205Medicaid