Provider Demographics
NPI:1326209172
Name:OHARA MEDICAL SUPPLIES & EQUIP LLC
Entity Type:Organization
Organization Name:OHARA MEDICAL SUPPLIES & EQUIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-671-0021
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-0489
Mailing Address - Country:US
Mailing Address - Phone:662-671-0021
Mailing Address - Fax:
Practice Address - Street 1:1069 CARROLL STREET
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-0489
Practice Address - Country:US
Practice Address - Phone:662-671-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies