Healthcare Provider Details

I. General information

NPI: 1710051206
Provider Name (Legal Business Name): ENTERPRISE AMBULENCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 513
ENTERPRISE MS
39330
US

IV. Provider business mailing address

PO BOX 245
ENTERPRISE MS
39330
US

V. Phone/Fax

Practice location:
  • Phone: 601-659-4533
  • Fax:
Mailing address:
  • Phone: 601-659-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number034
License Number StateMS

VIII. Authorized Official

Name: MRS. BILLIE C CRUMBLEY
Title or Position: DIRECTOR
Credential: BLS
Phone: 601-659-4533