Provider Demographics
NPI:1205932076
Name:MEDSTOCK, INC.
Entity type:Organization
Organization Name:MEDSTOCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT. CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-326-4433
Mailing Address - Street 1:206 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646
Mailing Address - Country:US
Mailing Address - Phone:662-326-4433
Mailing Address - Fax:662-326-2333
Practice Address - Street 1:206 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646
Practice Address - Country:US
Practice Address - Phone:662-326-4433
Practice Address - Fax:662-326-2333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTOCK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-16
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MSE7233332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440408Medicaid
1044490001Medicare NSC