Provider Demographics
NPI:1477980811
Name:LAUREL ADVANCED MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:LAUREL ADVANCED MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DEWAIN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-498-6867
Mailing Address - Street 1:1003 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2548
Mailing Address - Country:US
Mailing Address - Phone:601-426-2178
Mailing Address - Fax:601-426-2179
Practice Address - Street 1:1003 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2548
Practice Address - Country:US
Practice Address - Phone:601-426-2178
Practice Address - Fax:601-426-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12649/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies