Provider Demographics
NPI:1053716712
Name:ANGEL MEDICAL SUPPLY SERVICES
Entity type:Organization
Organization Name:ANGEL MEDICAL SUPPLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-3785
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1681
Mailing Address - Country:US
Mailing Address - Phone:662-843-3785
Mailing Address - Fax:662-843-3401
Practice Address - Street 1:8869 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:MS
Practice Address - Zip Code:38620-9692
Practice Address - Country:US
Practice Address - Phone:662-843-3785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL HOMEMAKER SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies