Organization
KAVANAUGH SUPPLIES LLC
Active
Other names
Freedom Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN KAVANAUGH (MANAGING MEMBER)
(601) 296-6763
Entity
Organization
Contact information
Practice address
22 98 PLACE BLVD, SUITE 10, HATTIESBURG, MS 39402-8603
(601) 296-6763
(601) 296-6764
Mailing address
22 98 PLACE BLVD, SUITE 10, HATTIESBURG, MS 39402-8603
(601) 296-6763
(601) 296-6764
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
037068103
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08876259
—
MS
Enumeration date
07/23/2006
Last updated
06/08/2009
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