Healthcare Provider Details

I. General information

NPI: 1396996997
Provider Name (Legal Business Name): ACS EMERGENCY SERVICES OF MISSISSIPPI PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E SUNFLOWER RD
CLEVELAND MS
38732-2833
US

IV. Provider business mailing address

PO BOX 636232
CINCINNATI OH
45263-6232
US

V. Phone/Fax

Practice location:
  • Phone: 662-846-0061
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDAL L DABBS
Title or Position: PRESIDENT
Credential: MD
Phone: 865-293-5210