Healthcare Provider Details

I. General information

NPI: 1841399938
Provider Name (Legal Business Name): MISS-LOU AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 COL JOHN PITCHFORD PKWY
NATCHEZ MS
39120-5280
US

IV. Provider business mailing address

PO BOX 965
NATCHEZ MS
39121-0965
US

V. Phone/Fax

Practice location:
  • Phone: 601-304-5350
  • Fax: 601-304-5508
Mailing address:
  • Phone: 601-304-5350
  • Fax: 601-304-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN SMITH
Title or Position: MANAGER
Credential:
Phone: 601-422-7281