Organization
MED-SOUTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY TODD KESTENBAUM (VICE PRESIDENT)
(601) 933-8400
Entity
Organization
Contact information
Practice address
7048 OLD CANTON RD STE 220, RIDGELAND, MS 39157-1021
(601) 933-8400
(601) 933-1103
Mailing address
PO BOX 1277, JACKSON, MS 39215-1277
(601) 933-8400
(601) 933-1103
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
04720/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440069
—
MS
Enumeration date
01/11/2006
Last updated
05/06/2019
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