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General NPI Number Information
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NPI Number | 1558739151
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Entity Type | Organization
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Legal Business Name | PRIME MED SERVICE INC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 5553 HIGHWAY 145
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City | SHANNON
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State | MS
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Zip | 38868-9351
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Country | US
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Telephone | 662-810-7075
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Fax | 662-810-7442
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Provider Business Mailing Address
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Address Line | 5553 HIGHWAY 145
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City | SHANNON
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State | MS
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Zip | 38868-9351
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Country | US
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Telephone | 662-810-7075
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Fax | 662-810-7442
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TONY PASS
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Credential |
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Telephone | 662-810-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | LGE 852
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License Number State | MS
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