Provider Demographics
NPI:1356332183
Name:MISSISSIPPI PHARMACEUTICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MISSISSIPPI PHARMACEUTICAL SERVICES, LLC
Other - Org Name:COLUMBIA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-736-0843
Mailing Address - Street 1:807 HIGHWAY 98 BYP
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-3710
Mailing Address - Country:US
Mailing Address - Phone:601-736-0843
Mailing Address - Fax:601-736-0845
Practice Address - Street 1:807 HIGHWAY 98 BYP
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3710
Practice Address - Country:US
Practice Address - Phone:601-736-0843
Practice Address - Fax:601-736-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MS05055/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440782Medicaid
MS00440782Medicaid
MS=========OtherPRIVATE INSURANCE ID