Provider Demographics
NPI:1629009063
Name:AVRITT MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:AVRITT MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:AVRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-7007
Mailing Address - Street 1:4020 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-8551
Mailing Address - Country:US
Mailing Address - Phone:662-843-7007
Mailing Address - Fax:662-843-7071
Practice Address - Street 1:909 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6930
Practice Address - Country:US
Practice Address - Phone:662-627-7702
Practice Address - Fax:662-627-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0390111.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03970589Medicaid
MS03970589Medicaid