Provider Demographics
NPI:1245561596
Name:CALYX MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CALYX MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-859-5401
Mailing Address - Street 1:111 LONE WOLF DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7029
Mailing Address - Country:US
Mailing Address - Phone:601-859-5401
Mailing Address - Fax:601-859-5434
Practice Address - Street 1:111 LONE WOLF DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7029
Practice Address - Country:US
Practice Address - Phone:601-859-5401
Practice Address - Fax:601-859-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08271/02.03336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6396270001Medicare NSC