Performance Mediequip Supply LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

PERFORMANCE MEDIEQUIP SUPPLY LLC

Practice address

4060 Popps Ferry Rd
Diberville, MS 39540-2378

Phone

(662) 719-8570

NPI assigned

Jul 26, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Joel Walters

Title

Owner

Phone

(662) 719-8570

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1568652568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 POPPS FERRY RD",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395402378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 POPPS FERRY RD",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395402378",
            "telephone_number": "662-719-8570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE MEDIEQUIP SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-719-8570",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Diberville, MS
• Providers in Diberville, MS by specialty
• Customized Equipment (DME) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.