Provider Demographics
NPI:1689980948
Name:BENEMED HOLDINGS, INC.
Entity Type:Organization
Organization Name:BENEMED HOLDINGS, INC.
Other - Org Name:JACKSON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-376-0855
Mailing Address - Street 1:5006 HIGHWAY 80 E STE B
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4224
Mailing Address - Country:US
Mailing Address - Phone:601-376-0855
Mailing Address - Fax:601-376-0854
Practice Address - Street 1:5006 HIGHWAY 80 E STE B
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4224
Practice Address - Country:US
Practice Address - Phone:601-376-0855
Practice Address - Fax:601-376-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06365/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6460550001Medicare NSC