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Organization
CHISOM MEDICAL GROUP LLC.
Active
Organization
CHISOM MEDICAL GROUP LLC.
Active
Other names
JACKSON MEDICAL SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SYLVESTER CHUKWUEMEKA OGUH (PRESIDENT/CEO)
(601) 454-3878
Entity
Organization
Contact information
Practice address
129 E MCDOWELL RD, JACKSON, MS 39204-5719
(601) 376-0855
(601) 376-0854
Mailing address
129 E MCDOWELL RD, JACKSON, MS 39204-5719
(601) 376-0855
(601) 376-0854
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
06365 / 11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00172074
—
MS
Enumeration date
03/22/2006
Last updated
08/22/2020
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