Provider Demographics
NPI:1821185059
Name:NEUROMAXX SURGICAL, INC
Entity Type:Organization
Organization Name:NEUROMAXX SURGICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-939-3270
Mailing Address - Street 1:3010 LAKELAND CV
Mailing Address - Street 2:SUITE L 1
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9784
Mailing Address - Country:US
Mailing Address - Phone:601-939-3270
Mailing Address - Fax:601-936-6675
Practice Address - Street 1:3010 LAKELAND CV
Practice Address - Street 2:SUITE L 1
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9784
Practice Address - Country:US
Practice Address - Phone:601-939-3270
Practice Address - Fax:601-936-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies