Provider Demographics
NPI:1457459620
Name:MISSISSIPPI LIMB BRACE AND DME, LLC
Entity Type:Organization
Organization Name:MISSISSIPPI LIMB BRACE AND DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:228-297-7152
Mailing Address - Street 1:1815 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3942
Mailing Address - Country:US
Mailing Address - Phone:228-875-2466
Mailing Address - Fax:228-875-2426
Practice Address - Street 1:1815 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3942
Practice Address - Country:US
Practice Address - Phone:228-875-2466
Practice Address - Fax:228-875-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5863550001Medicare NSC