Provider Demographics
NPI:1518146455
Name:INDIANOLA MEDICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:INDIANOLA MEDICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-207-8598
Mailing Address - Street 1:612 SUNFLOWER AVENUE EXT
Mailing Address - Street 2:BUILDING 1-A
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2333
Mailing Address - Country:US
Mailing Address - Phone:662-796-0705
Mailing Address - Fax:662-796-1270
Practice Address - Street 1:612 SUNFLOWER AVENUE EXT
Practice Address - Street 2:BUILDING 1-A
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2333
Practice Address - Country:US
Practice Address - Phone:662-796-0705
Practice Address - Fax:662-796-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6030020001Medicare NSC