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General NPI Number Information
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NPI Number | 1295712263
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Entity Type | Organization
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Legal Business Name | A SUPERIOR AMBULANCE PROVIDER OF LAMAR COUNTY, LLC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 116 MASON STREET
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City | LAUREL
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State | MS
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Zip | 39442-2727
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Country | US
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Telephone | 601-428-0060
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Fax | 601-425-3795
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Provider Business Mailing Address
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Address Line | 116 MASON STREET
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City | LAUREL
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State | MS
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Zip | 39442-2727
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Country | US
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Telephone | 601-428-0060
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Fax | 601-425-3795
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Authorized Official
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Title or Position | CFO
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Name | MRS. SHERI POWELL
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Credential |
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Telephone | 601-428-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 309
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License Number State | MS
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