Provider Demographics
NPI:1790059806
Name:COMMUNITY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-269-2973
Mailing Address - Street 1:410 S GLOSTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5526
Mailing Address - Country:US
Mailing Address - Phone:662-269-2973
Mailing Address - Fax:662-269-3186
Practice Address - Street 1:410 S GLOSTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5526
Practice Address - Country:US
Practice Address - Phone:662-269-2973
Practice Address - Fax:662-269-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10819-11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6703300001Medicare NSC