Provider Demographics
NPI:1982650651
Name:AMBULATORY EQUIPMENT SERVICE,INC
Entity Type:Organization
Organization Name:AMBULATORY EQUIPMENT SERVICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:III
Authorized Official - Credentials:CRT
Authorized Official - Phone:601-849-4112
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-0426
Mailing Address - Country:US
Mailing Address - Phone:601-849-4125
Mailing Address - Fax:601-849-7523
Practice Address - Street 1:805 3RD ST SW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111
Practice Address - Country:US
Practice Address - Phone:601-849-4125
Practice Address - Fax:601-849-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02319/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040047Medicaid
MS0170080001Medicare ID - Type Unspecified