Healthcare Provider Details

I. General information

NPI: 1366614901
Provider Name (Legal Business Name): WAYNE GENERAL AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MATTHEW DR
WAYNESBORO MS
39367-2567
US

IV. Provider business mailing address

950 MATTHEW DR
WAYNESBORO MS
39367-2567
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-5151
  • Fax: 601-735-7168
Mailing address:
  • Phone: 601-735-5151
  • Fax: 601-735-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number149
License Number StateMS

VIII. Authorized Official

Name: DAVID PORTER
Title or Position: CEO
Credential:
Phone: 601-735-7100