Organization
HERITAGE SOUTH MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLINE BRANDON (OWNER)
(662) 843-0142
Entity
Organization
Contact information
Practice address
201 W SUNFLOWER RD, CLEVELAND, MS 38732-2637
(662) 843-0142
(662) 846-7659
Mailing address
PO BOX 1449, CLEVELAND, MS 38732-1449
(662) 843-0142
(662) 846-7659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05527908
—
MS
01
—
450500088
BLUE CROSS BLUE SHIELD
MS
Enumeration date
10/06/2006
Last updated
07/29/2010
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