Phoenix Healthcare, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PHOENIX HEALTHCARE, LLC

Practice address

199 Interstate Dr
Suite U
Richland, MS 39218-4428

Phone

(601) 932-3397

Fax

(601) 932-3398

NPI assigned

Sep 21, 2006

Last updated

Sep 23, 2011By 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. Roland B Wall III

Title

Owner

Phone

(601) 932-3397

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Phoenix Healthcare, LLC

  • Durable Medical Equipment & Medical Supplies
  • Summit, MS
  • NPI 1962634337
  NPPES parent name

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1730288507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 INTERSTATE DR",
            "address_2": "SUITE U",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392184428",
            "telephone_number": "601-932-3397",
            "fax_number": "601-932-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 INTERSTATE DR",
            "address_2": "SUITE U",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392184428",
            "telephone_number": "601-932-3397",
            "fax_number": "601-932-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-932-3397",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06824216",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Optical 2000 of Richland
• Joyce Ann Pace, DMD
• Janu Patel
• Mark S Pearson, PHARMD
• Ashton Phillips
• Phoenix Specialtycare, LLC
• Physical Rehabilitation Management (Richland Physical Therapy)
• Jaycee Sue Pilcher
• Polk Dental Center
• James D Polk, M.D.

• Durable Medical Equipment & Medical Supplies in Richland, MS
• Providers in Richland, 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 Sep 23, 2011; 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.