Executive Medical Supplies LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0888/11.1 Issued in MS

Legal business name

EXECUTIVE MEDICAL SUPPLIES LLC

Practice address

209 N Fir Ave
Collins, MS 39428-9998

Phone

(601) 469-9040

NPI assigned

Nov 12, 2014

Organization subpart

Yes

Parent organization

EXECUTIVE MEDICAL SUPPLIES LLCAs reported in NPPES

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

Authorized official

Name

Milo Collins

Title

Owner

Phone

(601) 469-9040

Specialties & licenses 1

Addresses

Part of

Executive Medical Supplies LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Executive Medical Supplies LLC

  • Durable Medical Equipment & Medical Supplies
  • Forest, MS
  • NPI 1124312400
  NPPES parent name

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1801292214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E THIRD ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744101",
            "telephone_number": "601-469-9040",
            "fax_number": "601-469-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N FIR AVE",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394289998",
            "telephone_number": "601-469-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL SUPPLIES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXECUTIVE MEDICAL SUPPLIES LLC",
        "enumeration_date": "2014-11-12",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "MILO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-469-9040"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "0888/11.1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Jean Davis, NP
• Shelby Slade Dickerson, FNP-C
• Connie Durr, IDD WAIVER SERVICES
• Sharon Cranford Easterling, GNP-BC
• Enduracare Acute Care Services LLC
• Pamela Ferguson, CCSS
• Lylen Fisher
• Frankie Ford
• Bria Goff, FNP-C, MPH
• Marlecia Grant, DPT

• Durable Medical Equipment & Medical Supplies in Collins, MS
• Providers in Collins, 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 12, 2014; 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.