Provider Demographics
NPI:1366453490
Name:MICHAEL C CAMPBELL
Entity Type:Organization
Organization Name:MICHAEL C CAMPBELL
Other - Org Name:RELIABLE OXYGEN LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:601-587-0422
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654
Mailing Address - Country:US
Mailing Address - Phone:601-587-0422
Mailing Address - Fax:601-587-0423
Practice Address - Street 1:865 EAST BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654
Practice Address - Country:US
Practice Address - Phone:601-587-0422
Practice Address - Fax:601-587-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS039031216332B00000X
MS06711 11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04854364Medicaid
MS04854364Medicaid
MS04854364Medicaid