Healthcare Provider Details

I. General information

NPI: 1336786235
Provider Name (Legal Business Name): WMC EMERGENCY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17550 E MAIN ST
LOUISVILLE MS
39339-2772
US

IV. Provider business mailing address

PO BOX 967
LOUISVILLE MS
39339-0967
US

V. Phone/Fax

Practice location:
  • Phone: 662-773-6211
  • Fax:
Mailing address:
  • Phone: 662-446-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES WOODWARD
Title or Position: CONTROLLER
Credential:
Phone: 662-446-1072