Provider Demographics
NPI:1831123751
Name:DMED
Entity Type:Organization
Organization Name:DMED
Other - Org Name:DMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:CORKERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-573-0386
Mailing Address - Street 1:PO BOX 55671
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-5671
Mailing Address - Country:US
Mailing Address - Phone:601-573-0386
Mailing Address - Fax:601-856-8003
Practice Address - Street 1:558 HIGHWAY 6 E
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3002
Practice Address - Country:US
Practice Address - Phone:662-934-1076
Practice Address - Fax:662-563-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03720722Medicaid
MS5839840001Medicare ID - Type Unspecified