Organization
SOUTHERN PULMONARY CARE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL WAYNE MAHON CRT (OWNER)
(662) 489-3116
Entity
Organization
Contact information
Practice address
316A COFFEE ST, PONTOTOC, MS 38863-2606
(662) 489-3116
(662) 489-3388
Mailing address
PO BOX 41, PONTOTOC, MS 38863-0041
(662) 489-3116
(662) 489-3388
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
04138102.5
MS
332BX2000X
Oxygen Equipment & Supplies (DME)
02615/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040190
—
MS
Enumeration date
07/01/2005
Last updated
08/02/2011
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