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Organization
SOUTHERN PULMONARY CARE SERVICES INC
Active
Organization
SOUTHERN PULMONARY CARE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL WAYNE MAHON CRT (OWNER)
(662) 489-3116
Entity
Organization
Contact information
Practice address
316A COFFEE ST, PONTOTOC, MS 38863-2606
(662) 489-3116
(662) 489-3388
Mailing address
PO BOX 41, PONTOTOC, MS 38863-0041
(662) 489-3116
(662) 489-3388
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
04138102.5
MS
332BX2000X
Oxygen Equipment & Supplies (DME)
02615/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040190
—
MS
Enumeration date
07/01/2005
Last updated
08/02/2011
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