NPIMap

Organization Active NPI

Dura-Med Southeast Inc.

  • Durable Medical Equipment & Medical Supplies
  • Waynesboro, MS
National Provider Identifier
1053420034
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
04688/11.1 Issued in MS
Legal business name
DURA-MED SOUTHEAST INC.
Practice address
905 Shady Pine St
Waynesboro, MS 39367-2543
Phone
(601) 735-1633
Fax
(601) 735-1633
NPI assigned
Aug 30, 2006
Last updated
Feb 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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

Authorized official

Name
Jack R Floyd
Title
President
Phone
(850) 675-2448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 04688/11.1 MS Primary

Addresses

Primary practice location

905 Shady Pine St
Waynesboro, MS 39367-2543

Mailing address

905 Shady Pine St
Waynesboro, MS 39367-2543
Phone (601) 735-1633

Other identifiers 1

IdentifierTypeStateIssuer
00440934MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930078076 MS DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Oxygen & Equipment 0345243358 Practice locations: Waynesboro, MS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Dura-Med Southeast Inc.905 Shady Pine St, Waynesboro, MS 39367-2543(601) 735-1633 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Patient Li… Does not accept assignmentParticipating since Jan 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Dura-Med Southeast Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

905 Shady Pine St
Waynesboro, MS 39367
Phone (601) 735-1633

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1053420034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 SHADY PINE ST",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672543",
            "telephone_number": "601-735-1633",
            "fax_number": "601-735-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 SHADY PINE ST",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672543",
            "telephone_number": "601-735-1633",
            "fax_number": "601-735-1633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DURA-MED SOUTHEAST INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-675-2448"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "04688/11.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00440934",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesboro, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.