Provider Demographics
NPI:1588239420
Name:MID SOUTH MEDICAL LLC
Entity Type:Organization
Organization Name:MID SOUTH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, SALES
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:TERAL
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-926-4881
Mailing Address - Street 1:3602 LAUREL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2982
Mailing Address - Country:US
Mailing Address - Phone:336-926-4881
Mailing Address - Fax:919-294-4749
Practice Address - Street 1:3602 LAUREL CREEK WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2982
Practice Address - Country:US
Practice Address - Phone:336-926-4881
Practice Address - Fax:919-294-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies