Provider Demographics
NPI:1548248800
Name:DURA-QUIP MEDICAL EQUIPMENT INC.
Entity type:Organization
Organization Name:DURA-QUIP MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-774-8885
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:P O BOX 128
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-2521
Mailing Address - Country:US
Mailing Address - Phone:601-774-8885
Mailing Address - Fax:601-774-8810
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-2521
Practice Address - Country:US
Practice Address - Phone:601-774-8885
Practice Address - Fax:601-774-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02346/11.1332BX2000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040026Medicaid
MS00040026Medicaid