Organization
DIABETIC AND MEDIAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIE EVERITT (OWNER)
(662) 332-8848
Entity
Organization
Contact information
Practice address
1418 S MAIN ST, GREENVILLE, MS 38701-7026
(662) 332-8848
Mailing address
1418 S MAIN ST, GREENVILLE, MS 38701-7026
(662) 332-8848
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07634577
—
MS
Enumeration date
05/22/2007
Last updated
04/20/2008
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