Organization
MICHAEL R MULLINS II INC
Active
Other names
Southern Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAY MULLINS II (OWNER)
(304) 752-1450
Entity
Organization
Contact information
Practice address
301 GEORGE KOSTAS DR, LOGAN, WV 25601-3493
(304) 752-1450
(304) 752-4390
Mailing address
301 GEORGE KOSTAS DR, LOGAN, WV 25601-3493
(304) 752-1450
(304) 752-4390
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147367000
—
WV
Enumeration date
03/13/2007
Last updated
02/02/2015
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