1104232974 NPI number — JONES COUNTY MEDICAL SUPPLIES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104232974 NPI number — JONES COUNTY MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES COUNTY MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104232974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39441-0023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-426-2574
Provider Business Mailing Address Fax Number:
601-649-3185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 AZALEA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39367-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-735-3144
Provider Business Practice Location Address Fax Number:
601-735-3584
Provider Enumeration Date:
07/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRELAND
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
601-426-2574

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03456548 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com