Southgate Durable Medical Equipments

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

2473 Issued in MS

Legal business name

SOUTHGATE DURABLE MEDICAL EQUIPMENTS

Practice address

3352 Goodman Rd E
Southaven, MS 38672-6433

Phone

(662) 253-0021

Fax

(662) 253-0084

NPI assigned

Nov 7, 2006

Last updated

Nov 19, 2010By 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

Walter Osita Nnaemeka

Title

Owner

Phone

(662) 253-0021

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290124800000",
    "number": "1760551592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3352 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726433",
            "telephone_number": "662-253-0021",
            "fax_number": "662-253-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3352 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726433",
            "telephone_number": "662-253-0021",
            "fax_number": "662-253-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE DURABLE MEDICAL EQUIPMENTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2010-11-19",
        "status": "A",
        "authorized_official_last_name": "NNAEMEKA",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "OSITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-253-0021"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "2473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04150524",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE",
            "identifier": "4582511",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Southaven, MS
• Providers in Southaven, 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 Nov 19, 2010; 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.