Organization
THE MEDICAL STORE, INC.
Active
Parent organization
RUSH HEALTH SYSTEMS, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
RUSH HEALTH SYSTEMS, INC
Authorized official
MR. DON LARKIN KENNEDY (PRESIDENT)
(601) 703-9614
Entity
Organization
Contact information
Practice address
1911 14TH ST, MERIDIAN, MS 39301-4145
(601) 482-0099
Mailing address
PO BOX 5502, MERIDIAN, MS 39302-5502
(601) 482-0099
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
050-05340-4
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011075
BLUE CROSS BLUE SHIELD ID
MS
05
—
00040221
—
MS
05
—
008805990
—
AL
Enumeration date
09/22/2006
Last updated
04/21/2022
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