Provider Demographics
NPI:1518136613
Name:MICHAEL D BRASWELL
Entity Type:Organization
Organization Name:MICHAEL D BRASWELL
Other - Org Name:DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-8880
Mailing Address - Street 1:2536 BOBOLINK PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8107
Mailing Address - Country:US
Mailing Address - Phone:662-843-8880
Mailing Address - Fax:662-843-2280
Practice Address - Street 1:907 E SUNFLOWER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2830
Practice Address - Country:US
Practice Address - Phone:662-843-8880
Practice Address - Fax:662-843-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5294920001Medicare NSC