Organization
CHARTER MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH K GOWEN III (PRESIDENT)
(662) 533-9000
Entity
Organization
Contact information
Practice address
510 AZALEA DRIVE, SUITE 100, OXFORD, MS 38655
(662) 533-9000
(866) 838-7780
Mailing address
510 AZALEA DRIVE, SUITE 100, OXFORD, MS 38655
(662) 533-9000
(866) 838-7780
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
07500/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09458052
—
MS
Enumeration date
09/10/2007
Last updated
02/02/2015
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