Organization
GREAT SOUTH MEDICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY F LOUVIERE (OWNER)
(731) 664-8874
Entity
Organization
Contact information
Practice address
382 CARRIAGE HOUSE DR STE A, JACKSON, TN 38305-2299
(731) 664-8716
(731) 664-8932
Mailing address
382 CARRIAGE HOUSE DR STE A, JACKSON, TN 38305-2299
(731) 664-8716
(731) 664-8932
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000000507
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0183977
BCBS TN
—
01
—
B1203
BCBS LA
—
Enumeration date
04/13/2006
Last updated
06/05/2012
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