Provider Demographics
NPI:1477816197
Name:MEDSMART LLC
Entity Type:Organization
Organization Name:MEDSMART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-956-1330
Mailing Address - Street 1:5056 I 55 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4411
Mailing Address - Country:US
Mailing Address - Phone:601-956-1330
Mailing Address - Fax:601-956-1348
Practice Address - Street 1:5056 I 55 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-4411
Practice Address - Country:US
Practice Address - Phone:601-956-1330
Practice Address - Fax:601-956-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02053764Medicaid
MS6710540001Medicare NSC