Provider Demographics
NPI:1669489845
Name:DURA-QUIP MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:DURA-QUIP MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-469-3814
Mailing Address - Street 1:2039 HIGHWAY 35 SOUTH
Mailing Address - Street 2:P O BOX 960
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074
Mailing Address - Country:US
Mailing Address - Phone:601-469-3814
Mailing Address - Fax:601-469-3808
Practice Address - Street 1:2039 HIGHWAY 35 SOUTH
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074
Practice Address - Country:US
Practice Address - Phone:601-469-3814
Practice Address - Fax:601-469-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS03169/11.1332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440520Medicaid
MS00440520Medicaid