Organization
IV AT HOME INC.
Active
Other names
Breathe EZ
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E GRISHAM (PRESIDENT)
(662) 562-7007
Entity
Organization
Contact information
Practice address
119 WARD ST S, SENATOBIA, MS 38668-2638
(662) 562-7007
(662) 562-8009
Mailing address
119 WARD ST S, SENATOBIA, MS 38668-2638
(662) 562-7007
(662) 562-8009
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0409111.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440159
—
MS
Enumeration date
03/16/2007
Last updated
08/22/2020
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