Provider Demographics
NPI:1225146459
Name:STANDARD MEDICAL EQUIPMENT CORPORATION
Entity Type:Organization
Organization Name:STANDARD MEDICAL EQUIPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KALAGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-607-4192
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0420
Mailing Address - Country:US
Mailing Address - Phone:601-607-4192
Mailing Address - Fax:
Practice Address - Street 1:103 E FORD ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3409
Practice Address - Country:US
Practice Address - Phone:601-607-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07090/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01404720Medicaid
MS5770090001Medicare NSC