| Organization Name: | SOUTHERN PULMONARY CARE SERVICES INC |
| NPI Number: | 1740287028 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL WAYNE MAHON (OWNER) |
| Mailing Address: | 316a Coffee St Pontotoc |
| State: | MS US |
| Postal Code: | 388632606 |
| Phone Number: | 6624893116 |
| Fax Number: | 6624893388 |
| NPI Enumeration Date: | 07/01/2005 |
| NPI Last Update Date: | 08/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 02615/11.1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |