Provider Demographics
NPI:1922023860
Name:MID-DELTA DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:MID-DELTA DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-247-1254
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0373
Mailing Address - Country:US
Mailing Address - Phone:662-247-1254
Mailing Address - Fax:662-247-4924
Practice Address - Street 1:209 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3539
Practice Address - Country:US
Practice Address - Phone:662-247-3660
Practice Address - Fax:662-247-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04739/11.1332B00000X, 332BC3200X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS440825Medicaid
MS440825Medicaid