Provider Demographics
NPI:1609293604
Name:CAPITOL MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:CAPITOL MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCONTINENCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-842-3965
Mailing Address - Street 1:218 W LORENZ BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7058
Mailing Address - Country:US
Mailing Address - Phone:601-981-1861
Mailing Address - Fax:601-981-1869
Practice Address - Street 1:218 W LORENZ BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7058
Practice Address - Country:US
Practice Address - Phone:601-981-1861
Practice Address - Fax:601-981-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies