Mid-South Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MID-SOUTH MEDICAL SUPPLY LLC

Practice address

17860 Highway 432
Clinton, LA 70722-4026

Phone

(225) 683-6111

Fax

(225) 683-6885

NPI assigned

Mar 27, 2007

Last updated

Sep 14, 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. Michael Shannon Devall

Title

Owner

Phone

(225) 683-6111

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315958400000",
    "number": "1861510562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17860 HIGHWAY 432",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707224026",
            "telephone_number": "225-683-6111",
            "fax_number": "225-683-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17860 HIGHWAY 432",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707224026",
            "telephone_number": "225-683-6111",
            "fax_number": "225-683-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2011-09-14",
        "status": "A",
        "authorized_official_last_name": "DEVALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-683-6111",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "1114715",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Clinton, LA
• Providers in Clinton, LA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.