Organization
SOUTHGATE DURABLE MEDICAL EQUIPMENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER OSITA NNAEMEKA (OWNER)
(662) 253-0021
Entity
Organization
Contact information
Practice address
3352 GOODMAN RD E, SOUTHAVEN, MS 38672-6433
(662) 253-0021
(662) 253-0084
Mailing address
3352 GOODMAN RD E, SOUTHAVEN, MS 38672-6433
(662) 253-0021
(662) 253-0084
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2473
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04150524
—
MS
01
—
4582511
TENNCARE
TN
Enumeration date
11/07/2006
Last updated
11/19/2010
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