Provider Demographics
NPI:1578946844
Name:MAXIMUS SUPPLIES LLC
Entity Type:Organization
Organization Name:MAXIMUS SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-433-1187
Mailing Address - Street 1:3116 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5318
Mailing Address - Country:US
Mailing Address - Phone:912-433-1187
Mailing Address - Fax:912-777-3257
Practice Address - Street 1:3116 GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5318
Practice Address - Country:US
Practice Address - Phone:912-433-1187
Practice Address - Fax:912-777-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies