Provider Demographics
NPI:1255596524
Name:ALL INCLUSIVE MEDICAL, LLC
Entity type:Organization
Organization Name:ALL INCLUSIVE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:PERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-540-6851
Mailing Address - Street 1:931 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3912
Mailing Address - Country:US
Mailing Address - Phone:601-540-6851
Mailing Address - Fax:
Practice Address - Street 1:931 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3912
Practice Address - Country:US
Practice Address - Phone:601-540-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05952332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03683724Medicaid
MS4727970001Medicare NSC