Provider Demographics
NPI:1154030369
Name:KEYSTONE MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:KEYSTONE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-707-9727
Mailing Address - Street 1:106 HIGHLAND WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6933
Mailing Address - Country:US
Mailing Address - Phone:833-847-1240
Mailing Address - Fax:
Practice Address - Street 1:106 HIGHLAND WAY STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6933
Practice Address - Country:US
Practice Address - Phone:833-847-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies