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Organization
PERFORMANCE MEDIEQUIP SUPPLY LLC
Active
Organization
PERFORMANCE MEDIEQUIP SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL WALTERS (OWNER)
(662) 719-8570
Entity
Organization
Contact information
Practice address
4060 POPPS FERRY RD, DIBERVILLE, MS 39540-2378
(662) 719-8570
Mailing address
4060 POPPS FERRY RD, DIBERVILLE, MS 39540-2378
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
MS
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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