Provider Demographics
NPI:1144280041
Name:JONES COUNTY MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:JONES COUNTY MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:601-426-2574
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0023
Mailing Address - Country:US
Mailing Address - Phone:601-426-2574
Mailing Address - Fax:601-649-3185
Practice Address - Street 1:104 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4112
Practice Address - Country:US
Practice Address - Phone:601-426-2574
Practice Address - Fax:601-649-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01723/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS615825OtherBCBS TRIGON
MS000011873OtherBCBS OF MS
MS870001329OtherCAHABA GOVERNMENT BENEFIT
MS8230006OtherUNITED HEALTHCARE
MS00040750Medicaid
MS00040750Medicaid