MEDICARE: MADISON COUNTY CITIZENS SERVICES AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1518455468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON COUNTY CITIZENS SERVICES AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 1358
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-1358
Country	:	US
Telephone Number	:	601-391-1993
Fax Number	:	601-391-1997

Provider Business Practice Location Address
First Line	:	1005 W PEACE ST
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-5378
Country	:	US
Telephone Number	:	601-391-1993
Fax Number	:	601-391-1997

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. MARY SIMS-JOHNSON
Credential	:
Telephone Number	:	601-391-1993

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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