Healthcare Provider Details

I. General information

NPI: 1659693083
Provider Name (Legal Business Name): AMITE COUNTY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WEST FREEDOM DRIVE
LIBERTY MS
39645
US

IV. Provider business mailing address

PO BOX 511
LIBERTY MS
39645-0511
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-1236
  • Fax: 601-657-9181
Mailing address:
  • Phone: 601-657-1236
  • Fax: 601-657-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAM T. POOLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-657-4326