Healthcare Provider Details

I. General information

NPI: 1396849436
Provider Name (Legal Business Name): NORTH MISS AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 E CHAMBERS DRIVE
BOONEVILLE MS
38829
US

IV. Provider business mailing address

PO BOX 198408
ATLANTA GA
30384-8408
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-3201
  • Fax: 662-728-1403
Mailing address:
  • Phone: 330-762-8891
  • Fax: 330-384-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number067
License Number StateMS

VIII. Authorized Official

Name: MR. TIMOTHY DORN
Title or Position: CFO
Credential:
Phone: 303-495-1200