Healthcare Provider Details

I. General information

NPI: 1396744926
Provider Name (Legal Business Name): LAUDERDALE COUNTY EMS DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 17TH AVE
MERIDIAN MS
39301-5226
US

IV. Provider business mailing address

PO BOX 667
MERIDIAN MS
39302-0667
US

V. Phone/Fax

Practice location:
  • Phone: 601-485-2958
  • Fax: 601-482-1316
Mailing address:
  • Phone: 601-485-2958
  • Fax: 601-482-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number082-ALS-PARMEDIC
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number082
License Number StateMS

VIII. Authorized Official

Name: MR. TERRY JOE IRBY
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-485-2958