Organization
MID-SOUTH MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SHANNON DEVALL (OWNER)
(225) 683-6111
Entity
Organization
Contact information
Practice address
17860 HIGHWAY 432, CLINTON, LA 70722-4026
(225) 683-6111
(225) 683-6885
Mailing address
17860 HIGHWAY 432, CLINTON, LA 70722-4026
(225) 683-6111
(225) 683-6885
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114715
—
LA
Enumeration date
03/27/2007
Last updated
09/14/2011
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