Provider Demographics
NPI:1457568149
Name:INCARE INC
Entity Type:Organization
Organization Name:INCARE INC
Other - Org Name:INCARE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-981-1861
Mailing Address - Street 1:PO BOX 4199
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296
Mailing Address - Country:US
Mailing Address - Phone:601-981-1861
Mailing Address - Fax:601-981-1869
Practice Address - Street 1:1151 NORTH STATE ST
Practice Address - Street 2:SUITE 406
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:601-353-0407
Practice Address - Fax:601-981-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111945Medicaid