Provider Demographics
NPI:1871770305
Name:DIS SOLUTIONS LLC
Entity type:Organization
Organization Name:DIS SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPER OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RUSS
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-769-0280
Mailing Address - Street 1:PO BOX 2371
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 HOSPITAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2164
Practice Address - Country:US
Practice Address - Phone:662-320-9696
Practice Address - Fax:662-323-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04633/02.1332B00000X
MS04633/021332BP3500X
3336C0004X, 3336S0011X
MS046330213336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2587143OtherOTHER ID NUMBER
MS00330522Medicaid
MS000030527OtherBC BS OF MS HIT
MS00440638Medicaid
MS000030527OtherBC BS OF MS HIT