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General NPI Number Information
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NPI Number | 1386038958
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Entity Type | Organization
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Legal Business Name | MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 5226 HACKS CROSS RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8158
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Country | US
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Telephone | 662-404-8480
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Fax |
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Provider Business Mailing Address
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Address Line | 14290 GILLIS RD STE A
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-3724
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Country | US
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Telephone | 866-999-6339
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | JIM REEVES
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Credential |
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Telephone | 662-404-8480
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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 | 775
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License Number State | MS
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