Provider Demographics
NPI:1942748181
Name:DURABLE SUPPLY
Entity Type:Organization
Organization Name:DURABLE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:228-872-1386
Mailing Address - Street 1:1807 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3942
Mailing Address - Country:US
Mailing Address - Phone:228-872-1386
Mailing Address - Fax:228-872-1389
Practice Address - Street 1:1807 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3942
Practice Address - Country:US
Practice Address - Phone:228-872-1386
Practice Address - Fax:228-872-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08095/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies