Provider Demographics
NPI:1821654526
Name:SOUTH MISSISSIPPI MEDICAL SUPPLY AND VETERANS SERIVCES, LLC
Entity Type:Organization
Organization Name:SOUTH MISSISSIPPI MEDICAL SUPPLY AND VETERANS SERIVCES, LLC
Other - Org Name:SOUTH MS MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMPSHIRE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-596-4175
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 F E SELLERS HWY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-9556
Practice Address - Country:US
Practice Address - Phone:016-806-5046
Practice Address - Fax:601-806-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies