Organization
RANDY'S HOUSE OF MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE WYATT (OWNER)
(601) 785-6812
Entity
Organization
Contact information
Practice address
305 FRONT ST, TAYLORSVILLE, MS 39168
(601) 785-6812
(601) 785-4993
Mailing address
PO BOX 818, TAYLORSVILLE, MS 39168-0818
(601) 785-6812
(601) 785-4993
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
01523011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040383
—
MS
Enumeration date
03/06/2007
Last updated
08/22/2020
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