Provider Demographics
NPI:1255567228
Name:MID CITY DME INC
Entity type:Organization
Organization Name:MID CITY DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-3047
Mailing Address - Street 1:316 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3916
Mailing Address - Country:US
Mailing Address - Phone:601-425-3047
Mailing Address - Fax:601-425-3048
Practice Address - Street 1:316 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3916
Practice Address - Country:US
Practice Address - Phone:601-425-3048
Practice Address - Fax:601-425-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246615001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5642570001Medicare NSC