Provider Demographics
NPI:1801061445
Name:NATCHEZ MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:NATCHEZ MEDICAL SUPPLY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-5447
Mailing Address - Street 1:5703 GULF TECH DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8200
Mailing Address - Country:US
Mailing Address - Phone:228-872-5848
Mailing Address - Fax:228-875-5448
Practice Address - Street 1:5703 GULF TECH DR
Practice Address - Street 2:SUITE H
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-8200
Practice Address - Country:US
Practice Address - Phone:228-872-5848
Practice Address - Fax:228-875-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6320430001Medicare NSC