Provider Demographics
NPI:1063224467
Name:MID-MS MEDICAL
Entity type:Organization
Organization Name:MID-MS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:844-225-7160
Mailing Address - Street 1:3304 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4755
Mailing Address - Country:US
Mailing Address - Phone:844-225-7160
Mailing Address - Fax:386-343-7195
Practice Address - Street 1:3304 8TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4755
Practice Address - Country:US
Practice Address - Phone:844-225-7160
Practice Address - Fax:386-343-7195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIAL SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332H00000XSuppliersEyewear Supplier