Organization · NPI-2

Blackwater Medical LLC

Durable Medical Equipment & Medical Supplies · Hattiesburg, MS

NPI number1033343603
StatusActive
Last updated in NPPESMay 11, 2009

Details

NPI
1033343603
Entity type
Organization (NPI-2)
Legal business name
Blackwater Medical LLC
Organization subpart
No
Enumeration date
May 11, 2009
Last updated
May 11, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332B00000X Durable Medical Equipment & Medical Supplies––Yes

Practice location

1 Lincoln Pkwy
Suite #305
Hattiesburg, MS 39402-3262

Phone 601-264-0059 · Fax 866-691-3186

Mailing address

1 Lincoln Pkwy
Suite #305
Hattiesburg, MS 39402-3262

Phone 601-264-0059 · Fax 866-691-3186

Authorized official

James F Collins
President
6012640059

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