Organization
MARTHA DALE KRISTIANSEN
Active
Other names
MAK MEDICAL EQUIPMENT & RESPIRATORY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA DALE KRISTIANSEN (OWNER)
(601) 684-5115
Entity
Organization
Contact information
Practice address
1413 ASTON AVE, MCCOMB, MS 39648-2827
(601) 684-5115
(601) 684-5116
Mailing address
1413 ASTON AVE, MCCOMB, MS 39648-2827
(601) 684-5115
(601) 684-5116
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
057128480
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440487
—
MS
01
—
9000
ABP
MS
Enumeration date
11/01/2007
Last updated
08/12/2008
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