Provider Demographics
NPI:1992232722
Name:FREEDOM PROSTHETICS MS LLC
Entity type:Organization
Organization Name:FREEDOM PROSTHETICS MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-892-7745
Mailing Address - Street 1:303 E MARION AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7360 HIGHWAY 1
Practice Address - Street 2:SUITE 3
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4206
Practice Address - Country:US
Practice Address - Phone:601-892-7745
Practice Address - Fax:601-892-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies