NPIMap

Organization Active NPI

Midsouth Medical Specialties, LLC

  • Community/Retail Pharmacy
  • Hernando, MS
National Provider Identifier
1255677001
Registry record updated Dec 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11889 Issued in MS
Legal business name
MIDSOUTH MEDICAL SPECIALTIES, LLC
Doing business as
Super Drugs #2
Practice address
2260 Highway 515 South
Hernando, MS 38632
Phone
(662) 449-9075
Fax
(662) 449-3414
NPI assigned
Dec 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Authorized official

Name
Mr. Eddie O'Bannon
Title
Owner
Phone
(662) 449-9075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 11889 MS Primary

Addresses

Primary practice location

2260 Highway 515 South
Hernando, MS 38632

Mailing address

2260 Highway 515 South
Hernando, MS 38632
Phone (662) 449-9075

Other names 1

  • Super Drugs #2 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Misdouth Medical Specialties LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1255677001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 HIGHWAY 515 SOUTH",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "38632",
            "telephone_number": "662-449-9075",
            "fax_number": "662-449-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 HIGHWAY 515 SOUTH",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "38632",
            "telephone_number": "662-449-9075",
            "fax_number": "662-449-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH MEDICAL SPECIALTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "O'BANNON",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-449-9075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "11889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Drugs #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hernando, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.