Provider Demographics
NPI:1538280441
Name:QUEEN CITY MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:QUEEN CITY MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-693-6167
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1332
Mailing Address - Country:US
Mailing Address - Phone:601-693-6167
Mailing Address - Fax:601-693-6169
Practice Address - Street 1:1423 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4024
Practice Address - Country:US
Practice Address - Phone:601-693-6167
Practice Address - Fax:601-693-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08050855Medicaid
MS5677530001Medicare NSC