Provider Demographics
NPI:1316165350
Name:A1 HEALTHCARE
Entity type:Organization
Organization Name:A1 HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRIMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-362-9401
Mailing Address - Street 1:PO BOX 31055
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39286-1055
Mailing Address - Country:US
Mailing Address - Phone:601-362-9401
Mailing Address - Fax:601-366-5090
Practice Address - Street 1:2570 BAILEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-6905
Practice Address - Country:US
Practice Address - Phone:601-362-9401
Practice Address - Fax:601-366-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440424Medicaid
MS1139640001Medicare ID - Type Unspecified