Organization
TRI-STATE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFTON WADE GANT BS, RRT-NPS (CO-OWNER)
(662) 703-0317
Entity
Organization
Contact information
Practice address
6392 HIGHWAY 51 N, POPE, MS 38658-2421
(662) 703-0317
Mailing address
6392 HIGHWAY 51 N, POPE, MS 38658-2421
(662) 267-3112
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
01/12/2019
Last updated
06/04/2020
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