Organization
MIRACLE MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES EDWARD PUGH SR. (OWNER)
(601) 428-4668
Entity
Organization
Contact information
Practice address
111 ELLISVILLE BLVD, LAUREL, MS 39440-4519
(601) 428-4668
(601) 428-4668
Mailing address
111 ELLISVILLE BLVD, LAUREL, MS 39440-4519
(601) 428-4668
(601) 428-4668
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/30/2013
Last updated
12/10/2014
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