Blackwater Medical LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BLACKWATER MEDICAL LLC

Practice address

1 Lincoln Pkwy
Suite #305
Hattiesburg, MS 39402-3262

Phone

(601) 264-0059

Fax

(866) 691-3186

NPI assigned

May 11, 2009

Last updated

May 11, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James F Collins

Title

President

Phone

(601) 264-0059

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1033343603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE #305",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-264-0059",
            "fax_number": "866-691-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE #305",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-264-0059",
            "fax_number": "866-691-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKWATER MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-264-0059",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Bishop, O.T.
• William Bryan Bishop III, DO
• Imad Bitar, MD
• Robin Bixler, LPC
• Donna Maria Black, LCSW
• Blen D Blackwell, PA-C
• Kory Blackwell
• George Joshua Blair, MD
• Hayden Elise Blakeman
• Susan E Blakeney, FNP

• Durable Medical Equipment & Medical Supplies in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Durable Medical Equipment & Medical Supplies in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.