Provider Demographics
NPI:1972726651
Name:HYDECO LLC
Entity type:Organization
Organization Name:HYDECO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-241-0056
Mailing Address - Street 1:6958 HIGHWAY 50 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-9589
Mailing Address - Country:US
Mailing Address - Phone:662-241-0056
Mailing Address - Fax:662-241-0037
Practice Address - Street 1:910 TUSCALOOSA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-1616
Practice Address - Country:US
Practice Address - Phone:662-241-0056
Practice Address - Fax:662-241-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00686866Medicaid
5925840001Medicare NSC