Provider Demographics
NPI:1063536852
Name:HARRIS MEDICAL SUPPLY GROUP, LLC
Entity type:Organization
Organization Name:HARRIS MEDICAL SUPPLY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRIS
Authorized Official - Middle Name:CATON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LLM
Authorized Official - Phone:601-427-2469
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0806
Mailing Address - Country:US
Mailing Address - Phone:601-427-2469
Mailing Address - Fax:866-860-3857
Practice Address - Street 1:720 AVIGNON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5166
Practice Address - Country:US
Practice Address - Phone:601-427-2469
Practice Address - Fax:866-860-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies