Provider Demographics
NPI:1407889934
Name:LONGWIND PRODUCT & SERVICE, INC
Entity Type:Organization
Organization Name:LONGWIND PRODUCT & SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-366-2215
Mailing Address - Street 1:PO BOX 11838
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39283-1838
Mailing Address - Country:US
Mailing Address - Phone:601-366-2215
Mailing Address - Fax:601-366-9813
Practice Address - Street 1:205 W WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7647
Practice Address - Country:US
Practice Address - Phone:601-366-2215
Practice Address - Fax:601-366-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06693/11.1332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440160Medicaid
MS0755100001Medicare NSC