Provider Demographics
NPI:1376671537
Name:PICAYUNE MEDICAL & HEALTH SUPPLIES INC
Entity Type:Organization
Organization Name:PICAYUNE MEDICAL & HEALTH SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-798-2100
Mailing Address - Street 1:141 KIRKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3833
Mailing Address - Country:US
Mailing Address - Phone:601-798-2100
Mailing Address - Fax:601-798-5730
Practice Address - Street 1:141 KIRKWOOD ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3833
Practice Address - Country:US
Practice Address - Phone:601-798-2100
Practice Address - Fax:601-798-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0390811.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040265Medicaid
MS0402840001Medicare NSC