Organization
PATRICK E IGBOKWE
Active
Other names
Vicksburg Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK E IGBOKWE (OWNER/SOLE MEMBER)
(601) 636-3692
Entity
Organization
Contact information
Practice address
4798 HIGHWAY 61 S, SUITE B, VICKSBURG, MS 39180-7125
(601) 630-9300
(601) 630-0133
Mailing address
209 KENDRA DR, VICKSBURG, MS 39180-8986
(601) 630-9300
(601) 630-0133
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
07659/11.1
MS
Other
Enumeration date
04/22/2011
Last updated
06/27/2011
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