Provider Demographics
NPI:1952598153
Name:CMA MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:CMA MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FUNDERBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-354-7422
Mailing Address - Street 1:901 N STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2627
Mailing Address - Country:US
Mailing Address - Phone:601-354-7422
Mailing Address - Fax:601-355-5400
Practice Address - Street 1:901 N STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2627
Practice Address - Country:US
Practice Address - Phone:601-354-7422
Practice Address - Fax:601-355-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07517/11.1332BP3500X, 332BX2000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01955317Medicaid
MI=========OtherBCBS
MS6002470001Medicare NSC