Provider Demographics
NPI:1447324173
Name:TOLLEY VALERIE
Entity type:Organization
Organization Name:TOLLEY VALERIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-420-0064
Mailing Address - Street 1:371 TOWNE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4833
Mailing Address - Country:US
Mailing Address - Phone:601-420-0064
Mailing Address - Fax:601-420-0223
Practice Address - Street 1:818 2ND AVE NORTH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701
Practice Address - Country:US
Practice Address - Phone:662-329-5001
Practice Address - Fax:662-244-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06391111332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440861Medicaid
AL009985455Medicaid
TN4582223Medicaid
MS4081490002Medicare NSC