Provider Demographics
NPI:1891594438
Name:MIDSOUTH MEDICAL, INC.
Entity type:Organization
Organization Name:MIDSOUTH MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-855-0411
Mailing Address - Street 1:PO BOX 4927
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-4927
Mailing Address - Country:US
Mailing Address - Phone:318-855-0411
Mailing Address - Fax:
Practice Address - Street 1:9011 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6564
Practice Address - Country:US
Practice Address - Phone:318-687-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDSOUTH MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies