Provider Demographics
NPI:1598145807
Name:KEY MEDICAL SUPPLY,LLC
Entity Type:Organization
Organization Name:KEY MEDICAL SUPPLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMILO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:601-445-0005
Mailing Address - Street 1:123 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5103
Mailing Address - Country:US
Mailing Address - Phone:601-445-0005
Mailing Address - Fax:601-445-0370
Practice Address - Street 1:123 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-445-0005
Practice Address - Fax:601-445-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14270/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies