Provider Demographics
NPI:1982928768
Name:KILMICHAEL MEDICAL SUPPLIERS
Entity Type:Organization
Organization Name:KILMICHAEL MEDICAL SUPPLIERS
Other - Org Name:INHEALTH MEDICAL SUPPLIERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-283-1551
Mailing Address - Street 1:1300 SUNSET DR STE J
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4083
Mailing Address - Country:US
Mailing Address - Phone:662-227-2885
Mailing Address - Fax:662-227-2887
Practice Address - Street 1:1300 SUNSET DR STE J
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4083
Practice Address - Country:US
Practice Address - Phone:662-227-2885
Practice Address - Fax:662-227-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherEIN