MEDICARE: WMC EMERGENCY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1336786235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WMC EMERGENCY SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-0967
Country	:	US
Telephone Number	:	662-446-1072
Fax Number	:

Provider Business Practice Location Address
First Line	:	17550 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2772
Country	:	US
Telephone Number	:	662-773-6211
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. JAMES WOODWARD
Credential	:
Telephone Number	:	662-446-1072

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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