| Organization Name: | PERFORMANCE MEDIEQUIP SUPPLY LLC |
| NPI Number: | 1568652568 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOEL WALTERS (OWNER) |
| Mailing Address: | 4060 Popps Ferry Rd Diberville |
| State: | MS US |
| Postal Code: | 395402378 |
| Phone Number: | 6627198570 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2007 |
| NPI Last Update Date: | 07/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |