Provider Demographics
NPI:1467415414
Name:JONES COUNTY MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:JONES COUNTY MEDICAL SUPPLIES, INC
Other - Org Name:HATTIESBURG MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-296-6000
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0023
Mailing Address - Country:US
Mailing Address - Phone:601-296-6000
Mailing Address - Fax:601-296-2020
Practice Address - Street 1:1301 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3106
Practice Address - Country:US
Practice Address - Phone:601-296-6000
Practice Address - Fax:601-296-2020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONES COUNTY MEDICAL SUPPLIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-10
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04318/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440537Medicaid
MS00440537Medicaid
MS=========AOtherBLUE CROSS BLUE
MS=========AOtherBLUE CROSS BLUE