Provider Demographics
NPI:1841393956
Name:TRU-CARE MEDICAL ACKERMAN
Entity Type:Organization
Organization Name:TRU-CARE MEDICAL ACKERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:662-258-2176
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0000
Mailing Address - Country:US
Mailing Address - Phone:662-285-2176
Mailing Address - Fax:662-285-6904
Practice Address - Street 1:350 WEST CHERRY
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-0000
Practice Address - Country:US
Practice Address - Phone:662-285-2176
Practice Address - Fax:662-285-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06761111332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07777736Medicaid